Background:Breast cancer (BC) patients have heightened risks of atrial fibrillation (AF) and ischemic stroke (IS). Standard IS scores are poorly validated in cancer, omit cancer-specific factors, and guidelines offer no cancer-tailored management.Objectives:To develop and validate a novel score to predict IS risk in BC patients with AF.Methods:Data sources: UH Seidman Cancer Center (derivation; 40% set aside for internal validation) and MCG Cancer Center (external validation). Adults ≥ 18 years old with DCIS or stage I–IV BC who developed AF after diagnosis were included. Variable selection by LASSO Cox regression; continuous predictors dichotomized via cubic splines; points assigned from multivariable hazards to form B-S2CALED. Continuous scores were split into risk groups. Discrimination of categorized B-S2CALED versus CHA2DS2-VASc was assessed with the concordance index (C-index) and net reclassification improvement (NRI).Results:In the internal validation cohort (n = 935), 87 patients experienced IS/TIA. The B-S2CALED score achieved a C-index of 0.64 (95% CI 0.59–0.70) compared with 0.54 (95% CI: 0.51–0.56) for CHA2DS2-VASc, yielding a total NRI of 0.188. In the external validation cohort (n = 95), 8 patients developed IS/TIA. The B-S2CALED score produced a C-index of 0.77 (95% CI: 0.72–0.83) versus 0.53 (95% CI: 0.51–0.56) for CHA2DS2-VASc, with a total NRI of 0.563. Similar advantages were observed when the score was treated as a continuous variable.Conclusions:The BC-specific B-S2CALED score outperformed CHA2DS2-VASc for predicting thromboembolic events in BC patients with AF. Validation in larger datasets is needed before clinical adoption.
背景：乳腺癌患者发生心房颤动和缺血性脑卒中的风险增高。现有的标准脑卒中风险评分在癌症患者中验证不足，且未纳入癌症特异性因素，现行指南亦未提供针对癌症患者的个体化管理方案。 目的：开发并验证一种新型评分系统，用于预测合并房颤的乳腺癌患者的缺血性脑卒中风险。 方法：数据来源于UH Seidman癌症中心（推导队列；预留40%用于内部验证）和MCG癌症中心（外部验证）。研究对象为确诊后发生房颤的18岁及以上导管原位癌或I–IV期乳腺癌成年患者。通过LASSO Cox回归进行变量筛选；连续预测变量通过三次样条函数二分类化；根据多变量风险比分配分值，构建B-S2CALED评分。将连续评分划分为风险等级。采用一致性指数和净重分类改善指数评估分类化B-S2CALED评分与CHA2DS2-VASc评分的判别能力。 结果：在内部验证队列（n=935）中，87例患者发生缺血性脑卒中/短暂性脑缺血发作。B-S2CALED评分的C指数为0.64（95% CI 0.59–0.70），而CHA2DS2-VASc评分为0.54（95% CI: 0.51–0.56），总净重分类改善指数为0.188。在外部验证队列（n=95）中，8例患者发生缺血性脑卒中/短暂性脑缺血发作。B-S2CALED评分的C指数为0.77（95% CI: 0.72–0.83），而CHA2DS2-VASc评分为0.53（95% CI: 0.51–0.56），总净重分类改善指数达0.563。将评分作为连续变量处理时观察到相似优势。 结论：针对乳腺癌患者开发的B-S2CALED评分在预测合并房颤的乳腺癌患者血栓栓塞事件方面优于CHA2DS2-VASc评分。该评分在临床应用前需在更大规模数据集中进行验证。
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