食管癌患者调强放疗发生急性放射性肺损伤影响因素分析

Analysis of the associated factors of acute lung injury caused by intensity-modulated radiotherapy in patients with esophageal cancer

目的研究放疗相关因素及血清白介素-8(IL-8)、转化生长因子-β1(TGF-β1)水平对食管癌调强放疗(IMRT)患者急性放射性肺损伤(RILI)的影响。方法回顾性分析本院2018-01-01-2020-12-31收治的100例食管癌IMRT患者临床资料,依据其放疗后随访3个月出现急性RILI的程度分为急性RILI组(1~4级,30例)、无急性RILI组(0级,70例)。对2组临床资料进行单因素分析,并对其中差异有统计学意义的因素进行多因素二分类Logistic回归分析,进而筛选影响食管癌IMRT患者发生急性RILI的独立危险因素。结果单因素分析结果显示,急性RILI组有淋巴结转移(χ^(2)=5.820,P=0.041)、有基础肺疾病(χ^(2)=6.396,P=0.039)的患者占比均高于无急性RILI组;急性RILI组两肺平均V_(5)(t=9.207,P=0.028)、V_(10)(t=9.255,P=0.027)、V_(20)(t=9.776,P=0.025)、V_(30)(t=10.288,P=0.022)、MLD(t=12.842,P=0.016)、放疗前血清IL-8(t=11.668,P=0.020)、TGF-β1(t=4.480,P=0.043)水平均高于无急性RILI组;急性RILI组中KPS评分(t=7.792,P=0.037)低于无急性RILI组。多因素二分类Losgistic回归分析结果显示,有淋巴结转移(OR=1.855,95%CI为1.175~3.023,P=0.001)、有基础肺疾病(OR=2.067,95%CI为1.225~3.488,P<0.001)、MLD>10Gy(OR=2.326,95%CI为1.178~4.591,P=0.012)、V_(5)>60%(OR=1.879,95%CI为1.305~2.706,P=0.030)、V_(10)>40%(OR=2.479,95%CI为1.877~3.275,P=0.015)、V_(20)>28%(OR=1.960,95%CI为1.063~3.613,P=0.026)、V_(30)>20%(OR=1.910,95%CI为1.207~3.021,P=0.023)、KPS<80分(OR=1.451,95%CI为1.127~1.868,P=0.042)、放疗前血清IL-8>1000ng/L(OR=1.578,95%CI为1.137~2.189,P=0.028)均为食管癌调强放疗患者发生急性RILI的危险因素。结论有淋巴结转移、有基础肺疾病、MLD>10Gy、V_(5)>60%、V_(10)>40%、V_(20)>28%、V_(30)>20%、KPS<80分、放疗前血清IL-8>1000ng/L均为影响食管癌调强放疗患者急性RILI的危险因素。

Objective To investigate the effects of radiation-related factors and serum IL-8 and TGF-β1 levels on acute lung injury(RILI)in patients with intensity-modulated radiotherapy(IMRT)for esophageal cancer.Methods Retrospective analysis was performed on the clinical data of 100 patients with esophageal cancer who received IMRT admitted to Affiliated Hospital of Yangzhou University from January 1,2018 to December 31,2020.According to the severity of acute RILI(RTOG radiation injury classification standard)3 months after radiotherapy,they were divided into acute RILI group(grade 1-4,30 cases)and non-acute RILI group(grade 0,70 cases).Univariate analysis was performed on the clinical data of the two groups,and multivariate binary Logistic regression analysis was performed on the statistically significant differences among the factors,so as to screen the independent risk factors for the occurrence of acute RILI in patients with IMRT.Results Univariate analysis showed that there was lymph node metastasis in the acute RILI group(χ^(2)=5.820,P=0.041),underlying lung disease(χ^(2)=6.396,P=0.039)were higher than those without acute RILI group.The mean V_(5)of both lungs in acute RILI group(t=9.207,P=0.028),V_(10)(t=9.255,P=0.027),V_(20)(t=9.776,P=0.025),V_(30)(t=10.288,P=0.022),MLD(t=12.842,P=0.010),serum IL-8 before radiotherapy(t=11.668,P=0.020),TGF-β1(t=4.480,P=0.043)were higher than those in the non-acute RILI group.KPS score in acute RILI group(t=7.792,P=0.037)was lower than that in the non-acute RILI group,and the difference was statistically significant.Multivariate binary Logistic regression analysis showed lymph node metastasis(OR=1.855,95%CI:1.175-3.023,P=0.001),underlying lung disease(OR=2.067,95%CI:1.225-3.488,P<0.001),MLD>10Gy(OR=2.326,95%CI:1.178-4.591,P=0.012),V_(5)>60%(OR=1.879,95%CI:1.305-2.706,P=0.030),V_(10)>40%(OR=2.479,95%CI:1.877-3.275,P=0.015),V_(20)>28%(OR=1.960,95%CI:1.063-3.613,P=0.026),V_(30)>20%(OR=1.910,95%CI:1.207-3.021,P=0.023),KPS<80scores(OR=1.451,95%CI:1.127-1.868,P=0.042),serum IL-8>1000ng/L before radiotherapy(OR=1.578,95%CI:1.137-2.189,P=0.028)were risk factors for acute RILI in patients with intensity modulated radiotherapy for esophageal cancer,and the differences were statistically significant.Conclusion Lymph node metastasis,underlying lung disease,MLD>10Gy,V_(5)>60%,V_(10)>40%,V_(20)>28%,V_(30)>20%,KPS<80points,serum IL-8before radiotherapy>1000ng/L were risk factors for acute RILI in patients with esophageal cancer receiving IMRT.Therefore,clinical measures can be taken to prevent acute RILI in patients with esophageal cancer,thus improving the overall quality of life of patients.