{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T02:38:45Z","timestamp":1793500725837,"version":"4.5.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Cardiotoxicity is a serious adverse effect that can occur in women undergoing treatment for breast cancer. Identifying patients who will develop cardiotoxicity remains challenging.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To identify, describe, and evaluate all prognostic models developed to predict cardiotoxicity following treatment in women with breast cancer.<\/jats:p>\n <\/jats:sec>\n \n Evidence Review<\/jats:title>\n This systematic review searched the Medline, Embase, and Cochrane databases up to September 22, 2021, to include studies developing or validating a prediction model for cardiotoxicity in women with breast cancer. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess both the risk of bias and the applicability of the prediction modeling studies. Transparency reporting was assessed with the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) tool.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n \n After screening 590 publications, we identified 7 prognostic model studies for this review. Six were model development studies and 1 was an external validation study. Outcomes included occurrence of cardiac dysfunction (echocardiographic parameters), heart failure, and composite clinical outcomes. Model discrimination, measured by the area under receiver operating curves or\n C<\/jats:italic>\n statistic, ranged from 0.70 (95% IC, 0.62-0.77) to 0.87 (95% IC, 0.77-0.96). The most common predictors identified in final prediction models included age, baseline left ventricular ejection fraction, hypertension, and diabetes. Four of the developed models were deemed to be at high risk of bias due to analysis concerns, particularly for sample size, handling of missing data, and not presenting appropriate performance statistics. None of the included studies examined the clinical utility of the developed model. All studies met more than 80% of the items in TRIPOD checklist.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this systematic review of the 6 predictive models identified, only 1 had undergone external validation. Most of the studies were assessed as being at high overall risk of bias. Application of the reporting guidelines may help future research and improve the reproducibility and applicability of prediction models for cardiotoxicity following breast cancer treatment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.0569","type":"journal-article","created":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T11:02:10Z","timestamp":1677150130000},"page":"e230569","source":"Crossref","is-referenced-by-count":63,"title":["Risk Prediction Models for Cardiotoxicity of Chemotherapy Among Patients With Breast Cancer"],"prefix":"10.1001","volume":"6","author":[{"given":"Elis\u00e9 G.","family":"Kabor\u00e9","sequence":"first","affiliation":[{"name":"Health across Generations Team, Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Conor","family":"Macdonald","sequence":"additional","affiliation":[{"name":"Health across Generations Team, Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Kabor\u00e9","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Joseph Ki-Zerbo, Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Didier","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU Dijon-Bourgogne, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Arveux","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health, Unisant\u00e9, University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Meda","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Joseph Ki-Zerbo, Ouagadougou, Burkina Faso"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Boutron-Ruault","sequence":"additional","affiliation":[{"name":"Health across Generations Team, Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Guenancia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, CHU Dijon-Bourgogne, Dijon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,2,23]]},"reference":[{"issue":"3","key":"zoi230037r1","doi-asserted-by":"publisher","first-page":"209","DOI":"10.3322\/caac.v71.3","article-title":"Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.","volume":"71","author":"Sung","year":"2021","journal-title":"CA Cancer J Clin"},{"issue":"6","key":"zoi230037r2","doi-asserted-by":"publisher","first-page":"438","DOI":"10.3322\/caac.v69.6","article-title":"Breast cancer statistics, 2019.","volume":"69","author":"DeSantis","year":"2019","journal-title":"CA Cancer J Clin"},{"issue":"9","key":"zoi230037r3","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1038\/bjc.2015.68","article-title":"Who are the cancer survivors? a nationwide study in Denmark, 1943-2010.","volume":"112","author":"Hovaldt","year":"2015","journal-title":"Br J Cancer"},{"issue":"12","key":"zoi230037r4","doi-asserted-by":"publisher","first-page":"1231","DOI":"10.1016\/S1470-2045(15)00205-3","article-title":"The expanding role of primary care in cancer control.","volume":"16","author":"Rubin","year":"2015","journal-title":"Lancet Oncol"},{"issue":"36","key":"zoi230037r5","doi-asserted-by":"publisher","first-page":"2768","DOI":"10.1093\/eurheartj\/ehw211","article-title":"2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC).","volume":"37","author":"Zamorano","year":"2016","journal-title":"Eur Heart J"},{"issue":"8","key":"zoi230037r6","doi-asserted-by":"publisher","first-page":"651","DOI":"10.1016\/j.cardfail.2009.04.011","article-title":"Trastuzumab-induced cardiomyopathy: not as benign as it looks? a retrospective study.","volume":"15","author":"Guglin","year":"2009","journal-title":"J Card Fail"},{"issue":"2","key":"zoi230037r7","doi-asserted-by":"publisher","first-page":"48","DOI":"10.7812\/TPP\/14-241","article-title":"Breast cancer survivorship: a comprehensive review of long-term medical issues and lifestyle recommendations.","volume":"19","author":"Bodai","year":"2015","journal-title":"Perm J"},{"issue":"44","key":"zoi230037r8","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000005195","article-title":"Risk factors of trastuzumab-induced cardiotoxicity in breast cancer: a meta-analysis.","volume":"95","author":"Jawa","year":"2016","journal-title":"Medicine (Baltimore)"},{"issue":"11","key":"zoi230037r9","doi-asserted-by":"publisher","first-page":"1945","DOI":"10.1002\/ejhf.v22.11","article-title":"Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society.","volume":"22","author":"Lyon","year":"2020","journal-title":"Eur J Heart Fail"},{"issue":"12","key":"zoi230037r10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002989","article-title":"Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer: French CANTO cohort study.","volume":"16","author":"Kabor\u00e9","year":"2019","journal-title":"PLoS Med"},{"issue":"26","key":"zoi230037r11","doi-asserted-by":"publisher","first-page":"3157","DOI":"10.1200\/JCO.2016.67.4846","article-title":"Obesity as a risk factor for anthracyclines and trastuzumab cardiotoxicity in breast cancer: a systematic review and meta-analysis.","volume":"34","author":"Guenancia","year":"2016","journal-title":"J Clin Oncol"},{"key":"zoi230037r12","doi-asserted-by":"publisher","first-page":"i6460","DOI":"10.1136\/bmj.i6460","article-title":"A guide to systematic review and meta-analysis of prediction model performance.","volume":"356","author":"Debray","year":"2017","journal-title":"BMJ"},{"issue":"10","key":"zoi230037r13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001744","article-title":"Critical appraisal and data extraction for systematic reviews of prediction modelling studies: the CHARMS checklist.","volume":"11","author":"Moons","year":"2014","journal-title":"PLoS Med"},{"issue":"1","key":"zoi230037r14","doi-asserted-by":"publisher","first-page":"51","DOI":"10.7326\/M18-1376","article-title":"PROBAST: a tool to assess the risk of bias and applicability of prediction model studies.","volume":"170","author":"Wolff","year":"2019","journal-title":"Ann Intern Med"},{"key":"zoi230037r15","doi-asserted-by":"publisher","first-page":"g7594","DOI":"10.1136\/bmj.g7594","article-title":"Transparent reporting of a multivariable prediction model for individual prognosis or diagnosis (TRIPOD): the TRIPOD statement.","volume":"350","author":"Collins","year":"2015","journal-title":"BMJ"},{"issue":"31","key":"zoi230037r16","doi-asserted-by":"publisher","first-page":"3792","DOI":"10.1200\/JCO.2011.40.0010","article-title":"Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer.","volume":"30","author":"Romond","year":"2012","journal-title":"J Clin Oncol"},{"issue":"1","key":"zoi230037r17","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000472","article-title":"Risk prediction model for heart failure and cardiomyopathy after adjuvant trastuzumab therapy for breast cancer.","volume":"3","author":"Ezaz","year":"2014","journal-title":"J Am Heart Assoc"},{"key":"zoi230037r18","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/j.ijcard.2019.03.013","article-title":"Risk prediction model for long-term heart failure incidence after epirubicin chemotherapy for breast cancer\u2014a real-world data-based, nationwide classification analysis.","volume":"285","author":"Fogarassy","year":"2019","journal-title":"Int J Cardiol"},{"issue":"9","key":"zoi230037r19","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/j.jchf.2019.04.014","article-title":"Decline in left ventricular ejection fraction following anthracyclines predicts trastuzumab cardiotoxicity.","volume":"7","author":"Goel","year":"2019","journal-title":"JACC Heart Fail"},{"issue":"16","key":"zoi230037r20","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.021931","article-title":"Development and validation of a risk score model for predicting the cardiovascular outcomes after breast cancer therapy: the CHEMO-RADIAT score.","volume":"10","author":"Kim","year":"2021","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"zoi230037r21","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1016\/j.clbc.2019.04.012","article-title":"Personalized decision making in early stage breast cancer: applying clinical prediction models for anthracycline cardiotoxicity and breast cancer mortality demonstrates substantial heterogeneity of benefit-harm trade-off.","volume":"19","author":"Upshaw","year":"2019","journal-title":"Clin Breast Cancer"},{"issue":"7","key":"zoi230037r22","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1016\/j.amjcard.2017.12.022","article-title":"Usefulness of integrating heart failure risk factors into impairment of global longitudinal strain to predict anthracycline-related cardiac dysfunction.","volume":"121","author":"Milks","year":"2018","journal-title":"Am J Cardiol"},{"issue":"4","key":"zoi230037r23","doi-asserted-by":"publisher","first-page":"71","DOI":"10.21037\/atm","article-title":"Overview of clinical prediction models.","volume":"8","author":"Chen","year":"2020","journal-title":"Ann Transl Med"},{"issue":"25","key":"zoi230037r25","doi-asserted-by":"publisher","first-page":"3808","DOI":"10.1200\/JCO.2006.10.4976","article-title":"Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer.","volume":"25","author":"Pinder","year":"2007","journal-title":"J Clin Oncol"},{"issue":"2","key":"zoi230037r26","doi-asserted-by":"publisher","first-page":"333","DOI":"10.1007\/s10549-020-05703-5","article-title":"Cumulative incidence of chemotherapy-induced cardiotoxicity during a 2-year follow-up period in breast cancer patients.","volume":"182","author":"Cho","year":"2020","journal-title":"Breast Cancer Res Treat"},{"issue":"19","key":"zoi230037r27","doi-asserted-by":"publisher","first-page":"2078","DOI":"10.1200\/JCO.2013.54.0948","article-title":"Systemic therapy for patients with advanced human epidermal growth factor receptor 2-positive breast cancer: American Society of Clinical Oncology clinical practice guideline.","volume":"32","author":"Giordano","year":"2014","journal-title":"J Clin Oncol"},{"issue":"1","key":"zoi230037r28","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1186\/s12874-021-01440-5","article-title":"Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review.","volume":"21","author":"Bosco","year":"2021","journal-title":"BMC Med Res Methodol"},{"issue":"10","key":"zoi230037r29","doi-asserted-by":"publisher","first-page":"1063","DOI":"10.1093\/ehjci\/jeu192","article-title":"Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.","volume":"15","author":"Plana","year":"2014","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"zoi230037r30","doi-asserted-by":"publisher","first-page":"L19","DOI":"10.1093\/eurheartj\/suaa127","article-title":"Concepts in cardiac oncology.","volume":"22","author":"Bisceglia","year":"2020","journal-title":"Eur Heart J Suppl"},{"issue":"3","key":"zoi230037r31","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1007\/s12265-020-10042-3","article-title":"The role of biomarkers in cardio-oncology.","volume":"13","author":"Ananthan","year":"2020","journal-title":"J Cardiovasc Transl Res"},{"issue":"1","key":"zoi230037r32","doi-asserted-by":"publisher","first-page":"2795","DOI":"10.1038\/s41598-022-06698-3","article-title":"Dynamic personalized risk prediction in chronic heart failure patients: a longitudinal, clinical investigation of 92 biomarkers (Bio-SHiFT study).","volume":"12","author":"Klimczak-Tomaniak","year":"2022","journal-title":"Sci Rep"},{"issue":"12","key":"zoi230037r33","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1016\/j.amjcard.2013.08.026","article-title":"Review and meta-analysis of incidence and clinical predictors of anthracycline cardiotoxicity.","volume":"112","author":"Lotrionte","year":"2013","journal-title":"Am J Cardiol"},{"issue":"22","key":"zoi230037r34","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1161\/CIRCULATIONAHA.114.013777","article-title":"Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy.","volume":"131","author":"Cardinale","year":"2015","journal-title":"Circulation"},{"issue":"9","key":"zoi230037r35","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1136\/heartjnl-2011-301247","article-title":"Risk prediction models: II. External validation, model updating, and impact assessment.","volume":"98","author":"Moons","year":"2012","journal-title":"Heart"},{"key":"zoi230037r36","doi-asserted-by":"publisher","first-page":"m441","DOI":"10.1136\/bmj.m441","article-title":"Calculating the sample size required for developing a clinical prediction model.","volume":"368","author":"Riley","year":"2020","journal-title":"BMJ"},{"key":"zoi230037r37","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1016\/j.jclinepi.2016.02.031","article-title":"Adequate sample size for developing prediction models is not simply related to events per variable.","volume":"76","author":"Ogundimu","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"5","key":"zoi230037r38","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1016\/j.jclinepi.2004.06.017","article-title":"Substantial effective sample sizes were required for external validation studies of predictive logistic regression models.","volume":"58","author":"Vergouwe","year":"2005","journal-title":"J Clin Epidemiol"},{"key":"zoi230037r24","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-387-77244-8","volume-title":"Clinical prediction models: A Practical Approach to Development, Validation, and Updating","author":"Steyerberg","year":"2009"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2801738\/kabor_2023_oi_230037_1676399863.08659.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,23]],"date-time":"2023-02-23T11:02:13Z","timestamp":1677150133000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2801738"}},"subtitle":["A Systematic Review"],"short-title":[],"issued":{"date-parts":[[2023,2,23]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.0569","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,23]]}}}