非小细胞肺癌患者调强适形放疗致急性放射性肺损伤风险列线图模型的建立及验证  

Establishment and validation of a column chart model for the risk of acute radiation-induced lung toxicity induced by intensity modulated conformal radiotherapy in non-small cell lung cancer patients

作　　者：颜世娇 丁莉莉 李伟[1] YAN Shijiao;DING Lili;LI Wei(Department of Radiotherapy,the Second People′s Hospital of Huai′an,Huai′an,Jiangsu 223000,China)

机构地区：[1]淮安市第二人民医院放疗科,江苏淮安223000

出　　处：《临床肺科杂志》2024年第8期1187-1192,共6页Journal of Clinical Pulmonary Medicine

基　　金：江苏省干部保健科研项目(No.BJ21012)。

摘　　要：目的 建立非小细胞肺癌(NSCLC)患者调强适形放疗致急性放射性肺损伤(RILT)风险的列线图预测模型,并验证模型的预测效能。方法 纳入2020年1月~2023年2月期间本院收治的225例调强适形放疗的NSCLC患者为研究对象,收集临床资料,根据患者是否并发急性RILT分为对照组164例和急性RILT组61例。采用多因素Logistic回归分析筛选NSCLC患者调强适形放疗致急性RILT的影响因素;采用Bootstrap法做内部验证,Hosmer-Lemeshow检验、一致性指数(CI)、校正曲线、受试者工作特征(ROC)曲线评估列线图模型的预测效能。结果 急性RILT组年龄≥60岁、合并慢阻肺、双肺V20≥30%、双肺V30≥20%、淋巴结转移患者比例高于对照组,卡氏评分低于对照组,差异有统计学意义(P<0.05)。年龄≥60岁、合并慢阻肺、双肺V20≥30%、双肺V30≥20%、卡氏评分低、淋巴结转移是NSCLC患者调强适形放疗致急性RILT的独立危险因素(P<0.05)。列线图模型内部验证结果显示,Hosmer-Lemeshow检验χ^(2)=2.142,P=0.354,校正曲线与标准曲线拟合较好。ROC曲线评估结果显示曲线下面积为0.980(95%CI=0.965~0.996),敏感度为95.13%,特异度为91.51%。结论 基于独立危险因素构建的列线图预测模型对于NSCLC患者调强适形放疗致急性RILT具有较高的预测效能,可为改善患者预后提供参考。Objective To establish a column chart prediction model for the risk of acute radiation-induced lung toxicity(RILT)induced by intensity modulated conformal radiotherapy in non-small cell lung cancer(NSCLC)patients,and to verify the predictive efficacy of the model.Methods A total of 225 NSCLC patients treated with intensity modulated conformal radiotherapy in our hospital from January 2020 to February 2023 were collected as the study subjects.Clinical data were collected and divided into a control group of 164 cases and an acute RILT group of 61 cases based on whether the patient developed acute RILT.Multivariate logistic regression analysis was applied to screen the influencing factors of acute RILT induced by intensity modulated conformal radiotherapy in NSCLC patients;Bootstrap method was applied for internal validation,while the Hosmer-Lemeshow test,consistency index(CI),calibration curve,and subject operating characteristic(ROC)curve were applied to evaluate the predictive performance of the column chart model.Results The proportions of patients with age≥60 years old,concomitant chronic obstructive pulmonary disease,bilateral lung V20≥30%,bilateral lung V30≥20%,and lymph node metastasis in the acute RILT group were higher than those in the control group,and the Karnofsky score was lower than that in the control group(P<0.05).Age≥60 years old,concomitant chronic obstructive pulmonary disease,bilateral lung V20≥30%,bilateral lung V30≥20%,low Karnofsky score,and lymph node metastasis were independent risk factors for acute RILT caused by intensity modulated conformal radiotherapy in NSCLC patients(P<0.05).The internal validation results of the column chart model showed that the Hosmer-Lemeshow test wasχ^(2)=2.142,P=0.354,and the calibration curve fitted well with the standard curve.The evaluation results of the ROC curve showed that the area under the curve was 0.980 (95% CI =0.965~0.996),with a sensitivity of 95.13% and a specificity of 91.51%. Conclusion The column chart prediction model construct

关 键 词：非小细胞肺癌 调强适形放疗 急性放射性肺损伤 列线图 影响因素 

分 类 号：R734.2[医药卫生—肿瘤]