摘要
目的分析非小细胞肺癌(NSCLC)患者放射治疗(放疗)后发生症状性放射性肺炎(SRP)的影响因素,并构建预测模型。方法回顾性选取接受放疗的NSCLC患者364例,根据放疗结束后6个月内是否发生SRP分为SRP组90例和非SRP组274例。收集并比较两组患者的临床资料,包括性别、年龄、吸烟史、饮酒史、合并糖尿病、合并高血压、病理类型、肿瘤位置、TNM分期、体能状态评分、联合化疗、联合免疫治疗、联合靶向治疗、放疗模式、预后营养指数(PNI)、中性粒细胞与淋巴细胞比值(NLR)等基本资料,及放疗剂量、肿瘤靶体积、淋巴结靶体积、计划靶体积、左肺体积、右肺体积、全肺体积、接受超过一定剂量照射的肺容积占总肺容积百分比[肺V_(5)、肺V_(10)、肺V_(20)、肺V_(30)、肺V_(40)、肺V_(50)、肺V_(60)]和平均肺剂量(MLD)等放疗相关资料。采用多因素非条件Logistic回归分析法筛选NSCLC患者放疗后发生SRP的独立影响因素,并构建列线图模型;采用受试者工作特征(ROC)曲线、C指数、校准曲线、决策曲线评价模型的预测能力。结果SRP组年龄、联合化疗比例、NLR、肺V_(5)、肺V_(10)、肺V_(20)、肺V_(30)、MLD均高于非SRP组(P均<0.05),SRP组PNI低于非SRP组(P<0.05)。多因素非条件Logistic回归分析结果显示,年龄增加、联合化疗、肺V_(5)增加、MLD增加、NLR升高是NSCLC患者放疗后发生SRP的独立危险因素,PNI升高为独立保护因素(P均<0.05)。据此构建的NSCLC患者放疗后发生SRP列线图模型的C指数为0.919(95%CI:0.916~0.923),校准曲线与理想曲线贴合,决策曲线显示净获益范围较大。ROC曲线显示,该列线图模型预测NSCLC患者放疗后发生SRP的曲线下面积为0.919(95%CI:0.887~0.945),灵敏度和特异度分别为0.856、0.850。结论年龄、联合化疗、肺V_(5)、MLD、NLR、PNI为NSCLC患者放疗后发生SRP的独立影响因素,基于此构建的列线图模型可有效预测NSCLC患者放疗后发生SRP的风险,具有较高的区分能力、一致性及临床适用性。
Objective To analyze the influencing factors for symptomatic radiation pneumonitis(SRP)in patients with non-small-cell lung cancer(NSCLC)after radiotherapy and to construct a predictive model.Methods A total of 364 NSCLC patients who underwent radiotherapy were retrospectively selected and divided into the SRP group(90 cases)and non-SRP group(274 cases)based on the occurrence of SRP within 6 months after radiotherapy.Clinical data of the two groups were collected and compared,including basic information such as gender,age,smoking history,alcohol histo⁃ry,comorbid diabetes,comorbid hypertension,pathological type,tumor location,TNM stage,performance status score,combined chemotherapy,combined immunotherapy,combined targeted therapy,radiotherapy mode,prognostic nutritional index(PNI),neutrophil-to-lymphocyte ratio(NLR),as well as radiotherapy-related data such as radiation dose,tumor target volume,lymph node target volume,planning target volume,left lung volume,right lung volume,total lung vol⁃ume,percentage of total lung volume receiving a specific dose[lung V_(5),V_(10),V_(20),V_(30),V_(40),V_(50),and V_(60)],and mean lung dose(MLD).Multivariate unconditional Logistic regression analysis was used to identify independent influencing factors for SRP in NSCLC patients after radiotherapy,and a nomogram model was constructed.The predictive perfor⁃mance of the model was evaluated using the receiver operating characteristic(ROC)curve,C-index,calibration curve,and decision curve analysis.Results The SRP group had higher age,higher proportion of combined chemotherapy,high⁃er NLR,higher lung V_(5),V_(10),V_(20),V_(30),and higher MLD than the non-SRP group(all P<0.05),while the PNI was lower in the SRP group(P<0.05).Multivariate unconditional Logistic regression analysis showed that increased age,combined che⁃motherapy,increased lung V_(5),increased MLD,and elevated NLR were independent risk factors for SRP in NSCLC patients after radiotherapy,while elevated PNI was an independent protective factor(all P<0.05).The nomogram model construct⁃ed based on these factors had a C-index of 0.919(95%CI:0.916-0.923).The calibration curve closely aligned with the ideal curve,and the decision curve analysis showed a wide range of net benefits.The ROC curve demonstrated that the ar⁃ea under the curve(AUC)of the nomogram model for predicting SRP in NSCLC patients after radiotherapy was 0.919(95%CI:0.887-0.945),with the sensitivity and specificity of 0.8556 and 0.8504,respectively.Conclusions Age,combined chemotherapy,lung V_(5),MLD,NLR,and PNI are independent influencing factors for SRP in NSCLC patients after radiotherapy.The nomogram model constructed based on these factors can effectively predict the risk of SRP in NSCLC patients after radiotherapy,with high discriminative ability,consistency,and clinical applicability.
作者
刘媛媛
唐永红
何志鹏
周启源
LIU Yuanyuan;TANG Yonghong;HE Zhipeng;ZHOU Qiyuan(Cancer Radiation Therapy Center,The First Hospital of Hunan University of Chinese Medicine,Changsha 410021,China;不详)
出处
《山东医药》
2026年第1期18-23,共6页
Shandong Medical Journal
基金
湖南省科卫联合基金项目(2020JJ8003)
郴州市第一人民医院院内技术项目(2021B019)。
关键词
肺癌
非小细胞肺癌
放射治疗
放射性肺炎
症状性放射性肺炎
列线图
lung carcinoma
non-small-cell lung cancer
radiotherapy
radiation pneumonitis
symptomatic radia⁃tion pneumonitis
nomogram
