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Background <p>Cancer therapy-related cardiac dysfunction (CTRCD) is a significant complication of cancer therapy. While several factors contribute to its development, the role of oral health remains unexplored. This study examines the relationship between oral health, a potential modifiable risk factor, and the development of CTRCD in patients undergoing HER2-targeted therapy.</p> Methods <p>A retrospective study was conducted at a tertiary oncology center (SQCCCRC) with integrated cardio-oncology and specialized dental services. Adult women with early-stage or locally advanced HER2-positive breast cancer who received anthracycline-trastuzumab or anthracycline-free trastuzumab regimens between 2022 and 2025 were screened. Among 604 patients treated with trastuzumab, 307 completed all planned cycles and had at least one year of follow-up. After excluding patients with prior chemotherapy, major cardiovascular comorbidities, smoking, chronic kidney disease, ischemic heart disease, heart failure, dyslipidemia, and established risk factors for periodontitis, 62 patients who developed cancer therapy–related cardiac dysfunction (CTRCD) and 65 matched controls were included in the final analysis. Oral health was assessed using the DMFT index and periodontal staging/grading based on baseline dental evaluations performed before initiation of chemotherapy containing trastuzumab. Patients were then categorized into good or poor oral health groups. CTRCD was diagnosed and classified using echocardiographic findings, with recovery time documented. The primary outcome was CTRCD incidence; secondary outcomes included recovery time and significant changes in left ventricular ejection fraction (LVEF).</p> Results <p>Among patients with CTRCD, 64.5% had poor oral health, compared to 33.8% in the control group (<i>p</i> &lt; 0.001). Poor oral health was significantly associated with higher CTRCD risk (OR = 3.54; 95% CI: 1.76–7.14), delayed recovery (8 weeks vs. 4 weeks, <i>p</i> = 0.011), and a 3-fold higher likelihood of significant EF decline (&gt; 10%) (<i>p</i> = 0.0023). Associations with cardiac biomarkers (BNP and troponin) trended toward significance.</p> Conclusions <p>Poor oral health is significantly associated with increased risk and delayed recovery of CTRCD in patients receiving HER2-targeted therapy. These findings highlight oral health as a modifiable risk factor that may impact cardiac and oncologic outcomes. Future randomized controlled trials are needed to investigate further the potential benefits of dental interventions in preventing CTRCD.</p>

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The ROOT-CTRCD study: exploring the relationship of oral health to cancer therapy-related cardiac dysfunction in HER2-positive breast cancer patients

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月10日

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  • Ahmed Basuoni,
  • Khalid Al-Baimani,
  • Fatma AlKindi,
  • Waleed Dawelbeit,
  • Rawan AlHarrasi,
  • Hadil Al-Sharqi,
  • Nadiya AlKindi,
  • Amany Hany Mohamed Kamel

摘要

Background

Cancer therapy-related cardiac dysfunction (CTRCD) is a significant complication of cancer therapy. While several factors contribute to its development, the role of oral health remains unexplored. This study examines the relationship between oral health, a potential modifiable risk factor, and the development of CTRCD in patients undergoing HER2-targeted therapy.

Methods

A retrospective study was conducted at a tertiary oncology center (SQCCCRC) with integrated cardio-oncology and specialized dental services. Adult women with early-stage or locally advanced HER2-positive breast cancer who received anthracycline-trastuzumab or anthracycline-free trastuzumab regimens between 2022 and 2025 were screened. Among 604 patients treated with trastuzumab, 307 completed all planned cycles and had at least one year of follow-up. After excluding patients with prior chemotherapy, major cardiovascular comorbidities, smoking, chronic kidney disease, ischemic heart disease, heart failure, dyslipidemia, and established risk factors for periodontitis, 62 patients who developed cancer therapy–related cardiac dysfunction (CTRCD) and 65 matched controls were included in the final analysis. Oral health was assessed using the DMFT index and periodontal staging/grading based on baseline dental evaluations performed before initiation of chemotherapy containing trastuzumab. Patients were then categorized into good or poor oral health groups. CTRCD was diagnosed and classified using echocardiographic findings, with recovery time documented. The primary outcome was CTRCD incidence; secondary outcomes included recovery time and significant changes in left ventricular ejection fraction (LVEF).

Results

Among patients with CTRCD, 64.5% had poor oral health, compared to 33.8% in the control group (p < 0.001). Poor oral health was significantly associated with higher CTRCD risk (OR = 3.54; 95% CI: 1.76–7.14), delayed recovery (8 weeks vs. 4 weeks, p = 0.011), and a 3-fold higher likelihood of significant EF decline (> 10%) (p = 0.0023). Associations with cardiac biomarkers (BNP and troponin) trended toward significance.

Conclusions

Poor oral health is significantly associated with increased risk and delayed recovery of CTRCD in patients receiving HER2-targeted therapy. These findings highlight oral health as a modifiable risk factor that may impact cardiac and oncologic outcomes. Future randomized controlled trials are needed to investigate further the potential benefits of dental interventions in preventing CTRCD.