摘要
[目的]建立预测食管癌调强适形放疗致放射性肺损伤(radiation-induced lung toxicity,RILT)的列线图模型,并对模型的预测效能进行验证。[方法]选取2015年12月至2017年12月间行放射治疗的207例食管癌患者作为研究对象,采用简单交叉验证法随机将患者分为训练集(n=153)和验证集(n=54),回顾性分析训练集患者的临床资料,使用Logistic回归分析发生≥2级RILT的独立危险因素,并建立相关列线图预测模型。[结果]同期化疗、V5≥60%、V10≥40%、V20≥28%、V30≥20%、肺Dmean≥13Gy是食管癌调强适形放疗致≥2级RILT的独立危险因素(P<0.05)。基于以上6项独立危险因素建立预测食管癌调强适形放疗致≥2级RILT的列线图模型,并对该模型进行验证。训练集和验证集的C-index分别为0.831(95%CI:0.794~0.882)和0.784(95%CI:0.737~0.824),校正曲线均与标准曲线拟合较好,受试者工作特征(receiver operating characteristic,ROC)曲线下面积(area under curve,AUC)分别为0.917和0.890,表明该列线图模型具有良好的预测能力。[结论]基于危险因素建立的列线图模型具有良好的预测能力,可为临床筛查高风险患者和进一步改善患者预后提供参考依据。
[Objective]To establish a nomogram model in predicting radiation-induced lung toxicity(RILT)induced by intensity-modulated conformal radiotherapy(IMRT)for esophageal cancer,and to verify the predictive efficacy of the model.[Methods]The patients with esophageal cancer who underwent radiotherapy between December 2015 and December 2017 were selected as the research objects.The patients were randomly divided into training set(n=153)and verification set(n=54)by simple cross validation method.The clinical data of the patients in the training set were retrospectively analyzed,and Logistic regression was used to analyze the independent risk factors of RILT≥grade 2,and the related nomogram prediction model was established.[Results]Simultaneous chemotherapy,V5≥60%,V10≥40%,V20≥28%,V30≥20%,lung Dmean≥13 Gy were independent risk factors for≥grade 2 RILT caused by IMRT for esophageal cancer(P<0.05).Based on the above 6 independent risk factors,a nomogram model was established to predict RILT of≥grade 2 caused by IMRT,and the model was validated.The results show that the C-index indexes of the training set and the validation set are 0.831(95%CI:0.794~0.882)and 0.784(95%CI:0.737~0.824),respectively.The calibration curve fits well with the standard curve.The area under curve(AUC)of receiver operating characteristic(ROC)curve was 0.917 and 0.890,respectively,indicating that the nomogram model had good predictive ability.[Conclusion]The nomogram model established in this study based on risk factors has good predictive ability and can provide a reference for clinical screening of high-risk patients and further improve the prognosis of patients.
作者
王林林
姜文娟
WANG Lin-lin;JIANG Wen-juan(Lu’an City Hospital of Traditional Chinese Medicine,Lu’an 237006,China)
出处
《肿瘤学杂志》
CAS
2021年第5期374-379,共6页
Journal of Chinese Oncology
关键词
食管癌
调强适形放疗
放射性肺损伤
列线图
esophageal cancer
intensity-modulated conformal radiotherapy
radiationinduced lung injury
nomogram