局部晚期非小细胞肺癌患者心脏受照射剂量与预后的关系

Relationship between cardiac irradiation dose and prognosis of patients with advanced non-small cell lung cancer

目的探讨心脏放射剂量与局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的关系。方法回顾性分析2015年8月至2018年9月于河北省唐山市人民医院接受放射治疗的180例局部晚期NSCLC患者的临床数据和心脏剂量参数,采用K-M分析心脏剂量参数与总生存率的关系,通过多因素COX回归识别NSCLC患者预后的相关因子。结果NSCLC患者的中位生存时间为33.4个月。单因素分析提示计划靶区剂量≥56 Gy(HR1.54,95%CI1.28~2.86,P=0.011)、高血压(HR1.42,95%CI1.34~1.89,P=0.012)、平均心脏剂量≥13.9 Gy(HR1.12,95%CI1.05~2.61,P=0.031)、V5≥70%(HR1.08,95%CI1.01~2.16,P=0.044)、V30≥40%(HR1.16,95%CI1.04~3.01,P=0.041)、V50≥20%(HR1.23,95%CI1.11~2.81,P<0.001)和V60≥5%(HR1.03,95%CI1.00~1.89,P=0.037)是NSCLC患者预后的相关因素。经过多因素调整之后,化疗是NSCLC患者预后的有利因素(HR0.711,95%CI0.35~0.89,P=0.005);患有高血压是预后不良的相关因素(HR1.641,95%CI1.56~1.86,P=0.034);心脏剂量中的V50≥20%(HR1.161,95%CI1.13~3.82,P=0.002)是NSCLC患者预后不良的相关因素。结论心脏剂量中V50是晚期NSCLC患者预后的独立预测因子,心脏照射剂量的增加,可以增加潜在的死亡风险,临床实践中可以通过减少心脏放射剂量来改善患者预后。

Objective To explore the relationship between cardiac radiation dose and prognosis of patients with non-small cell lung cancer(NSCLC).Methods From August 2015 to September 2018,the clinical data and cardiac dose parameters of 180 patients with locally advanced NSCLC who received radiotherapy in Tangshan people′s Hospital of Hebei Province were analyzed retrospectively.The relationship between cardiac dose parameters and overall survival rate was analyzed by K-M analysis,and the prognostic factors of NSCLC patients were identified by multivariate Cox regression.Results The median survival time of NSCLC patients was 33.4 months.Univariate analysis indicated prescription dose≥56Gy(HR 1.54,95%CI1.28-2.86,P=0.011),hypertension(HR 1.42,95%CI1.34-1.89,P=0.012),mean cardiac dose≥13.9Gy(HR 1.12,95%CI1.05-2.61,P=0.031),V5≥70%(HR 1.08,95%CI1.01-2.16,P=0.044),and V30≥40%(HR 1.16,95%CI1.04-3.01,P=0.041),V50≥20%(HR 1.23,95%CI1.11-2.81,P<0.001),and V60≥5%(HR 1.03,95%CI1.00-1.89,P=0.037)were the prognostic factors of NSCLC patients.After multi-factor adjustments,receiving chemotherapy was a favorable factor for the prognosis of NSCLC patients(HR 0.711,95%CI0.35-0.89,P=0.005);hypertension was a factor of poor prognosis(HR 1.641,95%CI1.56-1.86,P=0.034);V50≥20%in cardiac dose(HR 1.161,95%CI1.13-3.82,P=0.002)was a poor prognostic factor in NSCLC patients.Conclusion The cardiac dose V50 is an independent predictor of prognosis in patients with advanced NSCLC.The increase of cardiac radiation dose may increase the potential risk of death.In clinical practice,the prognosis of patients may be improved by reducing the cardiac radiation dose.