局部晚期非小细胞肺癌患者调强放疗后发生急性放射性肺损伤的影响因素及风险预测模型研究

Influencing factors and risk prediction model of acute radiation-induced lung injury in patients with locally advanced non-small cell lung cancer after intensity-modulated radiotherapy

    摘要
  • 摘要:
    目的 探讨局部晚期非小细胞肺癌（NSCLC）患者调强放疗后发生急性放射性肺损伤的危险因素，并建立预测风险的列线图模型。
    方法 回顾性分析2017年5月至2019年11月于南京医科大学附属脑科医院行调强放疗的216例局部晚期NSCLC患者的临床资料，其中男性94例、女性122例，年龄37~83（61.5±9.6）岁。根据急性放射性肺损伤的发生情况将患者分为急性放射性肺损伤组和无急性放射性肺损伤组。计数资料的比较采用χ2检验，采用LASSO分析和Logistic回归分析筛选局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的独立危险因素，采用R软件包建立预测局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的风险列线图模型，计算一致性指数，绘制校正曲线、受试者工作特征（ROC）曲线和决策曲线。
    结果 216例局部晚期NSCLC患者调强放疗后有65例患者发生急性放射性肺损伤，发生率为30.09%。LASSO分析和Logistic回归分析结果显示，年龄、V5、V20、V30、平均肺剂量、第1秒用力呼气容积（FEV1）、放疗剂量分割模式及图像验证是局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的独立危险因素（OR=2.946~4.688，均P<0.05）。建立预测局部晚期NSCLC患者调强放疗后发生急性放射性肺损伤的风险列线图模型的一致性指数为0.819（95%CI：0.789~0.853），校正曲线与理想曲线相接近，ROC曲线下面积为0.802，决策曲线显示阈值概率在6%~100%时，具有较高的净获益值。
    结论 基于年龄、V5、V20、V30、平均肺剂量、FEV1、放疗剂量分割模式及图像验证建立的列线图对局部晚期NSCLC患者调强放疗后急性放射性肺损伤发生风险的预测具有较高的准确率。

     

    Abstract:
    Objective To investigate the risk factors of acute radiation-induced lung injury in patients with locally advanced non-small cell lung cancer (NSCLC) after intensity-modulated radio therapy (IMRT) and establish a nomogram model to predict the corresponding risk.
    Methods The clinical data of 216 patients with locally advanced NSCLC who were treated with IMRT in the Brain Hospital Affiliated to Nanjing Medical University from May 2017 to November 2019 were retrospectively analyzed, including 94 males and 122 females, with an average age of 37–83(61.5±9.6) years old. Based on the occurrence of acute radiation-induced lung injury, the selected patients with locally advanced NSCLC were divided into the acute radiation-induced lung injury group and the non-acute radiation-induced lung injury group. Herein, count data were compared using the χ2 test, LASSO analysis, and Logistic regression analysis used to screen independent risk factors of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT. In addition, the R software was used to predict the occurrence of acute radiation in patients with locally advanced NSCLC after IMRT. Risk nomogram model of lung injury, plotting calibration curve, receiver operating characteristic (ROC) curve, and decision curve.
    Results Among 216 patients with locally advanced NSCLC, acute radiation-induced lung injury occurred in 65 patients after IMRT, with an incidence rate of 30.09%. Logistic regression analysis showed that age, V5, V20, V30, mean lung dose, forced expiratory volume in the first second (FEV1), hypofractionated radiotherapy, and image verification are independent risk factors for acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT (OR=2.946–4.688, all P<0.05). The consistency index of the nomogram model for predicting the risk of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT was 0.819(95%CI: 0.789–0.853), the calibration curve was close to the ideal curve, and the area under the ROC curve was 0.802, the decision curve shows that when the threshold probability is between 6% and 100%, hence, there is a higher net benefit value.
    Conclusions The nomogram established based on age, V5, V20, V30, mean lung dose, FEV1, hypofractionated radiotherapy, and image verification has high accuracy in predicting the risk of acute radiation-induced lung injury in patients with locally advanced NSCLC after IMRT.

     

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