食管癌患者放射性肺损伤预测因素分析及其与COPD的相关性研究

Predictive Factors Analysis of Radiation-Induced Lung Injury in Patients with Esophageal Cancer and Its Correlation with COPD

目的分析食管癌患者放射性肺损伤(RILI)预测因素,以及其与慢性阻塞性肺疾病(COPD)的相关性。方法选取2014年1月~2017年12月我院收治的食管癌患者265例为研究对象,均行立体定向放射治疗(SBRT)治疗,治疗前均行肺功能检查,治疗后均行HRCT检查随访RILI的发生情况,回顾性分析RILI的预测因素及其与COPD是否存在相关性。结果0、1、2、3、4、5级RP发生率分别为38.49%、38.11%、17.74%、5.28%、0.38%、0,其中12例患有间质性肺疾病的患者,9例(75.00%)发生例3级以上的RILI;发生RILI≥1级的相关因素有年龄、总剂量、V20、GOLD分级;重度及极重度COPD组患者的0级RILI的发生率为54.17%,高于轻中度COPD组(42.31%)及无COPD组(30.22%)。结论年龄、总剂量、V20、GOLD分级与1级以上(有影像学变化)的RILI有相关性,重度COPD的RILI较正常或轻度COPD患者相对较轻,患有间质性肺疾病的患者多发生3级以上的RILI。

Objective To analyze the predictive factors of radiation-induced lung injury (RILI) in patients with esophageal cancer and its correlation with chronic obstructive pulmonary disease (COPD).Methods A total of 265 patients with esophageal cancer admitted to our hospital from January 2014 to December 2017 were enrolled in the study.All patients underwent stereotactic radiotherapy (SBRT).All patients underwent pulmonary function tests before treatment.All patients underwent HRCT follow-up after treatment.The incidence of radiation-induced lung injury,retrospective analysis of predictors of radiation-induced lung injury and its association with COPD.Results The incidence rates of 0,1,2,3,4,and 5 RP were 38.49%,38.11%,17.74%,5.28%,0.38%,and 0,of which 12 patients with interstitial lung disease and 9 patients (75.00%) Radioactive lung injury occurred in grade 3 or higher;age-related,total-dose,V20,and GOLD grades were associated with RILI ≥ 1 grade;grade 5 RILI was 54.17% in patients with severe and very severe COPD,higher than mild to moderate COPD group (42.31%) and no COPD group (30.22%).Conclusion The age,total dose,V20,and GOLD grades are related to RILI of grade 1 or above (with imaging changes).Severe chronic obstructive pulmonary disease (RILI) is relatively mild compared with normal or mild chronic obstructive pulmonary disease.More than grade 3 radiation-induced lung injury occurs in patients with pulmonary disease.