吡非尼酮预防食管癌放射性肺炎的初步探索:逆概率处理加权分析  

Preliminary report of pirfenidone for the prevention of radiation pneumonitis in patients with esophageal cancer:analysis using inverse probability of treatment weighting

作　　者：陈诚[1,2,3] 曾邦伟 薛聃[5] 杨志宇[1] 许齐真[1] 林壮镔 张晓琳 李小波 徐本华 Cheng Chen;Bangwei Zeng;Dan Xue;Zhiyu Yang;Qizhen Xu;Zhuangbin Lin;Xiaolin Zhang;Xiaobo Li;Benhua Xu(Department of Radiation Oncology,Fujian Medical University Union Hospital,Fuzhou 350000,China;College of Medical Technology and Engineering,Fujian Medical University,Fuzhou 350000,China;Union Clinical Medical College,Fujian Medical University,Fuzhou 350000,China;Nosocomial Infection Control Branch,Fujian Medical University Union Hospital,Fuzhou 350000,China;Pulmonary Department,Fujian Medical University Union Hospital,Fuzhou 350000,China;School of Clinical Medicine,Fujian Medical University,Fuzhou 350000,China)

机构地区：[1]福建医科大学附属协和医院放射肿瘤科,福州市350000 [2]福建医科大学医学技术与工程学院 [3]福建医科大学附属协和临床医学院 [4]福建医科大学附属协和医院感染管理科 [5]福建医科大学附属协和医院呼吸科 [6]福建医科大学临床医学部

出　　处：《中国肿瘤临床》2021年第15期772-776,共5页Chinese Journal of Clinical Oncology

摘　　要：目的:分析食管癌患者放疗期间预防性使用吡非尼酮对放射性肺炎的影响。方法:回顾性收集2017年11月至2020年1月于福建医科大学附属协和医院接受调强放疗(intensity-modulated radiation therapy,IMRT)的胸段食管癌患者资料,按是否使用吡非尼酮将患者分为吡非尼酮组和对照组,通过逆概率处理加权法(inverse probability of treatment weighting,IPTW)将各协变量在两组人群进行加权处理,分析两组人群2级及3级以上放射性肺炎的发生率。结果:共纳入170例符合要求的病例,其中吡非尼酮组40例,对照组130例。中位随访时间22.6个月,通过对年龄、吡非尼酮用药史、放疗剂量、双肺V_(5)及V_(20)等可能影响放射性肺炎发生的临床因素及肺体积剂量参数等进行IPTW法加权分析,加权后两组基线特征标准化均值差值下降99.72%,两组2级以上、3级以上放射性肺炎发生率分别为3.92%vs.14.73%(P=0.0007)及3.92%vs.10.99%(P=0.0141),差异均有统计学意义。多因素Logistic回归分析发现吡非尼酮用药史(2级P=0.0017,3级P=0.0191)、年龄(2级P=0.0336,3级P=0.0028)、放疗剂量(2级P=0.0119,3级P=0.0031)均与2级和3级以上放射性肺炎相关。吡非尼酮组未发现明显的不良反应。结论:接受IMRT治疗食管癌患者,放疗期间同步使用吡非尼酮可有效降低2级及3级以上放射性肺炎的发生,安全性好,值得开展进一步临床研究证实。Objective:To analyze the prophylactic effect of pirfenidone on radiation pneumonitis in patients with esophageal cancer during radiotherapy.Methods:The data of patients with esophageal cancer treated with intensity-modulated radiation therapy(IMRT)from November 2017 to January 2020 in Fujian Medical University Union Hospital were retrospectively collected.Patients were assigned into two groups:the pirfenidone group and the control group,according to the use of pirfenidone.Propensity score-based inverse probability of treatment weighting(IPTW)was used to analyze differences in the incidence rates of grade≥2 and grade≥3 radiation pneumonitis between two groups.Results:In total,170 patients with esophageal cancer treated with IMRT were included.Forty patients were included in the pirfenidone group,and 130 patients were included in the control group.The median follow-up duration was 22.6 months.These factors included age,history of pirfenidone use,radiotherapy dose,and the percent of the total lung volume exceeding 5Gy(V_(5))and V_(20).After IPTW analysis,the difference in baseline characteristics between the two groups decreased by 99.72%.The incidence rates of grade≥2 and grade≥3 radiation pneumonitis were 3.92%vs.14.73%(P=0.0007)and 3.92%vs.10.99%(P=0.0141)in the pirfenidone group vs.control group,respectively.Multivariate Logistic regression analysis showed that pirfenidone use(grade 2:P=0.0017,grade 3:P=0.0191),age(grade 2:P=0.0336,grade 3:P=0.0028),and radiotherapy dose(grade 2:P=0.0119,grade 3:P=0.0031)were associated with the incidence of grade≥2 and grade≥3 radiation pneumonitis.No significant adverse reactions were found in the pirfenidone group.Conclusions:In patients with esophageal cancer treated with IMRT,the concurrent use of pirfenidone during radiotherapy can effectively reduce the incidence of grade≥2 and grade≥3 radiation pneumonitis,with good safety.However,further clinical studies are needed.

关 键 词：食管癌 吡非尼酮 预防 放射性肺炎 调强放疗 

分 类 号：R735.1[医药卫生—肿瘤]