喉癌部分切除术联合放疗后肺炎发生的剂量学因素分析及风险预测列线图模型构建  

Dosimetric factor analysis of the incidence of post-radiotherapy pneumonia after partial resection of laryngeal cancer and construction of a risk prediction nomogram model

作　　者：黄蓉 卢晓旭 孙学明 贺家琪 吴慧 Huang Rong;Lu Xiaoxu;Sun Xueming;He Jiaqi;Wu Hui(Department of Radiation,Affiliated Tumor Hospital of Zhengzhou University,Henan Tumor Hospital,Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院放疗科,郑州450008

出　　处：《中华肿瘤杂志》2025年第2期160-167,共8页Chinese Journal of Oncology

摘　　要：目的探讨喉癌部分切除术联合放疗后3个月内患者发生肺炎的影响因素,并构建肺炎发生风险的列线图预测模型。方法2017—2023年于郑州大学附属肿瘤医院接受喉癌部分切除术联合术后放疗的喉鳞状细胞癌患者165例,根据肺炎的发生情况分为未发生肺炎组、低风险肺炎组和中高风险肺炎组。采用受试者工作特征(ROC)曲线明确喉部平均照射剂量(Larynx-Dmean)和咽缩肌平均照射剂量(PCM-Dmean)预测肺炎发生的最佳界值。采用logistic回归分析筛选出喉癌部分切除术联合放疗后3个月内肺炎发生的影响因素,构建列线图预测模型。结果165例患者中,未发生肺炎组59例,低风险肺炎组60例,中高风险肺炎组46例,肺炎的总体发生率为64.2%(106/165)。ROC曲线分析显示,Larynx-Dmean预测肺炎是否发生的曲线下面积(AUC)为0.876,最佳界值为60.8 Gy,当Larynx-Dmean>60.8 Gy时,肺炎发生率为96.7%。PCM-Dmean预测肺炎是否发生的AUC为0.747,最佳界值为54.6 Gy,当PCM-Dmean>54.6 Gy时,肺炎发生率为74.7%。Larynx-Dmean预测中高危肺炎发生的AUC为0.987,最佳界值为68.2 Gy,当Larynx-Dmean>68.2 Gy时,中高危肺炎发生率为100.0%。PCM-Dmean预测中高危肺炎发生的AUC为0.850,最佳界值为58.7 Gy,当PCM-Dmean>58.7 Gy时,中高危肺炎发生率为85.2%。多因素logistic回归分析显示,有吸烟史(OR=1.54,95%CI:1.02~1.74)、吸烟指数越高(OR=2.43,95%CI:1.16~7.59)、Larynx-Dmean越高(OR=3.79,95%CI:1.25~6.49)、PCM-Dmean越高(OR=2.44,95%CI:1.53~3.16)肺炎的发生率越高。成功构建喉癌部分切除术联合放疗后3个月内肺炎和中高危肺炎发生风险的列线图预测模型,C指数分别为0.78和0.98,具有良好的预测性能及临床效能。结论喉癌部分切除术后放疗Larynx-Dmean>60.8 Gy、PCM-Dmean>54.6 Gy时,3个月内患者发生肺炎的可能性大幅增加。吸烟史、吸烟指数、Larynx-Dmean和PCM-Dmean是肺炎发生的独立影响因素,据此构建的列线�Objective To explore the influencing factors for pneumonia occurrence within three months in patients undergoing partial laryngectomy combined with radiotherapy,and to construct a nomogram prediction model for the risk of pneumonia occurrence.Methods A total of 165 patients with laryngeal squamous cell carcinoma who underwent partial laryngectomy combined with postoperative radiotherapy in the Affiliated Cancer Hospital of Zhengzhou University from 2017 to 2023 were divided into three groups:a group without pneumonia,a low risk pneumonia group,and a medium to high risk pneumonia group according to the occurrence of pneumonia.The receiver operating characteristic(ROC)curve was used to determine the optimal cutoff values of the mean dose to the larynx(Larynx-Dmean)and the mean dose to the pharyngeal constrictor muscles(PCM-Dmean)for predicting the occurrence of pneumonia.Logistic regression analysis was used to screen out the influencing factors of pneumonia within three months after partial laryngectomy combined with radiotherapy,and a nomogram prediction model was constructed.Results Among the 165 patients,59 were in the group without pneumonia,60 were in the group with a low risk of pneumonia,and 46 were in the group with a medium to high risk of pneumonia.The overall incidence of pneumonia was 64.2%(106/165).ROC curve analysis showed that the area under the curve(AUC)of the Larynx-Dmean for predicting the occurrence of pneumonia was 0.876,and the optimal cutoff value was 60.8 Gy.When the Larynx-Dmean was>60.8 Gy,the incidence of pneumonia was 96.7%.The AUC of the PCM-Dmean for predicting the occurrence of pneumonia was 0.747,and the optimal cutoff value was 54.6 Gy.When the PCM-Dmean was>54.6 Gy,the incidence of pneumonia was 74.7%.The AUC of the Larynx-Dmean for predicting the occurrence of medium to high risk pneumonia was 0.987,and the optimal cutoff value was 68.2 Gy.When the Larynx-Dmean was>68.2 Gy,the incidence of medium to high risk pneumonia was 100.0%.The AUC of the PCM-Dmean for predicting the occurr

关 键 词：喉肿瘤 放射治疗 肺炎 剂量学因素 列线图 

分 类 号：R739.65[医药卫生—肿瘤]