高原藏族人群肺癌放疗所致放射性肺损伤敏感性分析

Sensitivity analysis for radiation-induced lung injury caused by radiotherapy for lung cancer patients in Tibetan Plateau, China

目的 探讨高原藏族人群肺癌放疗所致RILI的相关因素.方法 2012-2016年间经病理或细胞学证实的NSCLC患者共262例,其中世居海拔3000m以上高原藏族人群138例,非世居高原藏族人群或非藏族人群124例,所有患者行IMRT±化疗,且放疗后CT随访＞6个月.对≥2级RILI患者分别就民族、年龄、性别、KPF评分、临床分期、是否联合化疗及有无吸烟史因素进行相关分析;并对两组人群分别就性别、吸烟史、有无同期化疗及不同放射剂量与RILI相关性进行分析.放疗剂量体积参数采用x2检验或Fisher＇s精确概率法,各剂量体积参数相关性采用Pearson法,采用Logistic回归模型进行因素分析.结果 262例NSCLC患者中民族、性别、KPS评分、有无吸烟史及MLD、V5、V20因素均与RILI相关（P=0.040、0.001、0.026、0.014、0.037、0.000、0.025）.进一步分析显示,仅吸烟史与人口组成相关（P=0.013）,不同人群辐射剂量与RILI发生无相关性（P均＞0.05）.结论 世居高原藏族NSCLC患者人群对放疗更易发生RILI.

Objective To investigate the factors associated with radiation-induced lung injury （RILI） caused by radiation therapy for lung cancer patients in Tibetan Plateau,China.Methods A total of 262 patients with non-small cell lung cancer （NSCLC） confirmed by pathology or cytology from April 2012 to February 2016,consisting of 138 native Tibetans living at an elevation over 3 000 meters and 124 non-native Tibetans or non-Tibetan people,were analysed.All patients received intensity-modulated radiotherapy ± chemotherapy and underwent CT follow-up for over 6 months.For patients with grade ≥ 2 RILI,the associations of ethnicity,age,sex,Kamofsky Performance Scale （KPS） score,clinical stage,chemotherapy,and smoking history with RILI were analyzed.For two groups of patients,native Tibetan population and non-native Tibetan population,the associations of sex,smoking history,chemotherapy,and radiation dose with RILI were analyzed.Radiation dose-volume parameters were compared using the chisquare test or＇s＇s exact test,and their correlations were analyzed using the Person correlation test;a multivariate analysis was performed using the logistic regression model.Results For the 262 NSCLC patients,ethnicity （P=0.040）,sex （P=0.001）,KPS score （P=0.026）,presence or absence of smoking history （P =0.014）,minimum lethal dose （P =0.037）,V5 （P =0.000）,and V20 （P=0.025）were found to be associated with the development of RILI.Further analysis showed that only the smoking history （P=0.013） was significantly correlated with demographic composition.And there was no significant relationship between radiation dose for different groups and the incidence of RILI （all P=＞ 0.05）.Conclusions Native Tibetan patients with NSCLC are more susceptible to RILI.