Validation of a predictive index of early cardiotoxicity due to chemotherapy in patients with breast cancer
Keywords:
cardiotoxicidad; cáncer de mama; quimioterapia; predicción; índice de riesgo; validación; Cardiooncología.Abstract
Introduction: Chemotherapy-induced cardiotoxicity is one of the leading causes of mortality in patients with breast cancer. Currently, there is no validated predictive index capable of identifying the risk of developing this complication at an early stage.
Objective: To validate a predictive index for early cardiotoxicity caused by chemotherapy in patients with breast cancer.
Methods: An analytical cohort study was conducted in 629 breast cancer patients treated with anthracyclines and taxanes at the Carlos Manuel de Céspedes Hospital in Bayamo, Cuba, between January 2019 and May 2022. A predictive index was developed using a sample of 327 patients and validated in an independent cohort of 302 patients. Sensitivity, specificity, predictive values, internal consistency (Cronbach’s alpha), calibration (Hosmer-Lemeshow test), and discriminatory capacity were evaluated. The index was compared against the SCORE2 scale as a reference standard.
Results: The index demonstrated excellent discriminatory capacity (area under the curve: 0.927 in the development cohort and 0.871 in the validation cohort). Sensitivity was 80.3% and specificity 99.2%, with a positive predictive value of 93.1% and a negative predictive value of 86.5%. The Hosmer-Lemeshow test showed good calibration (p = 0.222). Cronbach’s alpha coefficient was 0.712. The index outperformed SCORE2 in predictive power and clinical applicability in this setting.
Conclusions: The validated index reliably predicts the risk of cardiotoxicity and represents a useful tool for risk stratification and the implementation of cardioprotective strategies.
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