摘要
目的探讨食管鳞状细胞癌调强放疗模式下急性放射性肺炎(ARP)的危险因素及预测模型的构建。方法回顾性选取2018年2月至2025年1月在西安交通大学第二附属医院接受调强放疗治疗的食管鳞状细胞癌患者206例作为研究对象,根据是否发生ARP分为ARP组(75例)和非ARP组(131例)。比较两组一般临床资料。采用多因素Logistic逐步回归分析探讨食管鳞状细胞癌患者调强放疗模式下ARP的影响因素;构建列线图模型,并评估其对食管鳞状细胞癌患者调强放疗模式下ARP的预测价值。结果ARP组糖尿病、临床分期(Ⅲ~Ⅳ期)、淋巴结转移、平均肺剂量(MLD)、双肺V5、双肺V20和C反应蛋白(CRP)水平高于非ARP组,淋巴细胞、白蛋白水平低于非ARP组,差异有统计学意义(P<0.05)。多因素Logistic逐步回归分析显示,糖尿病、淋巴结转移、MLD、双肺V5、CRP是食管鳞状细胞癌患者调强放疗模式下ARP的危险因素(OR=1.853,95%CI:1.357~2.531,P<0.001;OR=2.065,95%CI:1.457~2.927,P<0.001;OR=2.568,95%CI:1.685~3.913,P<0.001;OR=2.762,95%CI:1.816~4.201,P<0.001;OR=2.641,95%CI:1.736~4.017,P<0.001)。列线图模型显示,一致性指数为0.903(95%CI:0.849~0.957)。Hosmer-Lemeshow拟合优度检验显示,该列线图模型没有过度拟合现象(χ^(2)=0.753,P=0.429);原始曲线接近于理想曲线。列线图模型预测食管鳞状细胞癌患者调强放疗模式下ARP的曲线下面积为0.882(95%CI:0.829~0.935),特异度为68.16%,敏感度为91.58%。结论糖尿病、淋巴结转移、MLD、双肺V5、CRP为食管鳞状细胞癌患者调强放疗模式下ARP的影响因素,以上述因素构建的列线图模型对ARP具有一定的预测价值。
Objective To explore the risk factors for acute radiation pneumonitis(ARP)in patients with esophageal squamous cell carcinoma undergoing intensity-modulated radiotherapy and to construct a prediction model.Methods A total of 206 patients with esophageal squamous cell carcinoma who received intensity-modulated radiotherapy in the Second Affiliated Hospital of Xi'an Jiaotong University from February 2018 to January 2025 were retrospectively included.They were divided into the ARP group(75 cases)and the non-ARP group(131 cases)based on ARP occurrence.General clinical data were compared between groups.Multivariate Logistic stepwise regression analysis was used to identify influencing factors for ARP.A nomogram model was constructed and its predictive value was evaluated.Results The proportions of diabetes,clinical stage(Ⅲ-Ⅳ),and lymph node metastasis,mean lung dose(MLD),V5 and V20 of both lungs,and C-reactive protein(CRP)levels in the ARP group were significantly higher than in the non-ARP group,while lymphocyte and albumin levels in the ARP group were significantly lower than that in the non-ARP group(P<0.05).Multivariate Logistic stepwise regression analysis showed that diabetes,lymph node metastasis,MLD,V5 of both lungs,and CRP were independent risk factors for ARP(OR=1.853,95%CI:1.357-2.531,P<0.001;OR=2.065,95%CI:1.457-2.927,P<0.001;OR=2.568,95%CI:1.685-3.913,P<0.001;OR=2.762,95%CI:1.816-4.201,P<0.001;OR=2.641,95%CI:1.736-4.017,P<0.001).The nomogram showed a consistency index of 0.903(95%CI:0.849-0.957).Hosmer-Lemeshow test indicated no overfitting(χ^(2)=0.753,P=0.429),with the calibration curve approximating the ideal line.The AUC for ARP prediction was 0.882(95%CI:0.829-0.935),with 68.16%specificity and 91.58%sensitivity.Conclusion Diabetes,lymph node metastasis,MLD,V5 of both lungs,and CRP levels are risk factors for ARP in cases with esophageal squamous cell carcinoma undergoing intensity-modulated radiotherapy.The nomogram model constructed based on these factors has certain predictive value for ARP.
作者
苏王辉
何赟
李芳
潘继元
孟鑫
黄园清
李毅
SU Wanghui;HE Yun;LI Fang;PAN Jiyuan;MENG Xin;HUANG Yuanqing;LI Yi(Department of Radiation Oncology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an,Shaanxi 710000,China)
出处
《转化医学杂志》
2025年第7期35-40,共6页
Translational Medicine Journal
基金
陕西省重点研发计划项目(2024SF-YBXM-123)。
关键词
食管鳞状细胞癌
调强放疗
急性放射性肺炎
危险因素
列线图
Esophageal squamous cell carcinoma
Intensity-modulated radiotherapy
Acute radiation pneumonitis
Risk factors
Nomogram
