乳腺癌术后辅助放疗过程中中性粒细胞减少症发生的危险因素分析  

RISK FACTORS FOR NEUTROPENIA DURING POSTOPERATIVE ADJUVANT RADIOTHERAPY FOR BREAST CANCER

作　　者：金龙[1] 曹菲 张沥[3] 马少君[4] JIN Long;CAO Fei;ZHANG Li;MA Shaojun(Department of Radiation Oncology,Shaanxi Provincial People’s Hospital,Xi′an 710068,China)

机构地区：[1]陕西省人民医院放疗科,陕西西安710068 [2]陕西省人民医院肿瘤内科,陕西西安710068 [3]陕西省人民医院MRI室,陕西西安710068 [4]陕西省人民医院放射科,陕西西安710068

出　　处：《精准医学杂志》2023年第6期530-534,共5页Journal of Precision Medicine

基　　金：陕西省重点研发计划社会发展领域项目(2020-SF-056);西安市创新能力强基计划医学研究项目(21YXYJ0094)。

摘　　要：目的探讨乳腺癌术后辅助放疗过程中发生2级及以上中性粒细胞减少症的危险因素。方法选取2018年1月—2020年12月我院收治的乳腺癌术后辅助放疗患者93例,分为对照组(未发生或发生1级中性粒细胞减少症,62例)和观察组(发生2级及以上中性粒细胞减少症,31例),对两组患者临床资料行单因素及logistic回归分析,分析2级及以上中性粒细胞减少症发生的独立危险因素,并采用受试者工作特征(ROC)曲线确立危险因素的预测效能。结果单因素分析结果显示,两组患者的乳腺癌分子分型、初诊白细胞计数、初诊中性粒细胞绝对值、化疗期间4级骨髓抑制患者构成比、放疗前白细胞计数、放疗前中性粒绝对值、放疗前血红蛋白、放疗计划靶区体积(PTV)、放疗胸骨平均照射剂量(Dmean)、胸骨接受大于20 Gy照射体积与总体积之比(V20)及接受大于30 Gy照射体积与总体积之比(V30)等指标差异具有显著性(χ^(2)=4.511、9.900,t=2.286~9.900,P<0.05)。多因素logistic回归分析结果显示,PTV及胸骨Dmean增加为2级及以上中性粒细胞减少症独立危险因素(P<0.05)。绘制的ROC曲线显示,PTV的cut-off值为733.28 mL,AUC为0.664,灵敏度83.9%,特异度56.5%;胸骨Dmean的cut-off值为2213.5 cGy,AUC为0.749,灵敏度80.6%,特异度67.7%;两指标联合预测2级及以上中性粒细胞减少症的AUC为0.786,灵敏度96.8%,特异度58.4%。结论PTV>733.28 mL和胸骨Dmean>2213.5 cGy是乳腺癌术后辅助放疗过程中2级及以上中性粒细胞减少症发生的独立危险因素,两指标联合可提高该症是否发生的预测效能。Objective To explore the risk factors for neutropenia(grade 2 or higher)during postoperative adjuvant radiotherapy for breast cancer.Methods A total of 93 patients with breast cancer treated by postoperative adjuvant radiotherapy in Shaanxi Provincial People’s Hospital from January 2018 to December 2020 were assigned to a control group(no neutropenia or grade 1 neutropenia,n=62)and an observation group(grade 2 or higher neutropenia,n=31).The clinical data of the two groups were analyzed by univariate and logistic regression analyses to determine the independent risk factors for grade 2 or higher neutropenia,and the predictive efficacy of risk factors was established by the receiver operating characteristic(ROC)curve.Results The univariate analysis results showed that there were significant differences between the two groups in molecular types of breast cancer,white blood cell count and absolute neutrophil count at the first visit,proportion of patients with grade 4 myelosuppression during chemotherapy,white blood cell count,absolute neutrophil count,hemoglobin before radiotherapy,planning target volume(PTV),mean radiotherapy dose to the sternum(Dmean),and ratio of volume exposed to radiation greater than 20 Gy to total vo-lume and ratio of volume exposed to radiation greater than 30 Gy to total volume in the sternum(χ^(2)=4.511,9.900,t=2.286-9.900,P<0.05).The logistic regression analysis results showed that PTV and sternum Dmean were independent risk factors for grade 2 or higher neutropenia(P<0.05).The ROC curves showed a cut-off value of 733.28 mL for PTV,with an area under the curve(AUC)of 0.664,a sensitivity of 83.9%,and a specificity of 56.5%,and a cut-off value of 2213.5 cGy for sternum Dmean,with an AUC of 0.749,a sensitivity of 80.6%,and a specificity of 67.7%;the AUC of the two indices for the combined prediction of grade 2 or higher neutropenia was 0.786,with a sensitivity of 96.8%and a specificity of 58.4%.Conclusion PTV>733.28 mL and sternum Dmean>2213.5 cGy are independent risk factors for grade 2

关 键 词：乳腺肿瘤 放射疗法 辅助 中性粒细胞减少 放射治疗剂量 放疗计划靶区体积 危险因素 

分 类 号：R737.9[医药卫生—肿瘤] R557.1[医药卫生—临床医学]