血清TGF-β、IL-6联合正常肺组织并发症概率对肺癌放疗继发放射性肺炎的早期预测价值

Value of serum TGF-β, IL-6 combined with normal lung tissue complication probability in early prediction of secondary radiation pneumonitis in lung cancer patients undergoing radiotherapy

目的 探究血清转化生长因子-β(TGF-β)、白细胞介素-6(IL-6)联合正常肺组织并发症概率(NTCP)对肺癌(LC)放疗继发放射性肺炎(RP)的早期预测价值。方法 选取2018年7月-2020年7月于重庆大学附属肿瘤医院行放疗的125例LC患者为研究对象,根据RP发生情况分为RP组28例和非RP组97例。收集患者一般资料及检测放疗前1 d和放疗5周时以及放疗完成后1 d血清TGF-β、IL-6水平、放疗5周时NTCP,单因素和多因素Logistic回归分析LC放疗继发RP的相关影响因素;受试者工作特征(ROC)曲线评价血清TGF-β、IL-6联合NTCP对LC放疗继发RP的早期预测价值。结果 125例LC患者中有28例(22.40%)继发RP,多为Ⅱ级,多发生于放疗后1个月内;单因素和多因素分析显示:放疗剂量、放疗5周时NTCP是LC放疗继发RP的影响因素(P<0.05);RP组患者放疗中血清TGF-β水平、放疗后血清TGF-β水平、放疗前血清IL-6水平、放疗中血清IL-6水平、放疗后血清IL-6水平均高于非RP组,差异均有统计学意义(P<0.05)。ROC分析显示:LC放疗继发RP患者,放疗中血清TGF-β、放疗中血清IL-6、放疗5周NTCP等3指标均具有早期预测价值,联合应用价值高于各指标单独应用(P<0.05)。结论 血清TGF-β、IL-6联合NTCP对LC放疗继发RP具有较高的早期预测价值和临床参考价值。

OBJECTIVE To explore the value of serum transforming growth factor-β(TGF-β), interleukin-6(IL-6) and normal lung tissue complication probability(NTCP) in prediction of secondary radiation pneumonitis(RP) in lung cancer(LC) patients undergoing chemotherapy. METHODS Totally 125 LC patients who received chemotherapy in Cancer Hospital Affiliated to Chongqing University from Jul 2018 to Jul 2020 were recruited as the research subjects and divided into the RP group with 28 cases and the non-RP group with 97 cases according to the status of RP. The baseline data were collected from the patients, the levels of serum TGF-β and IL-6 were detected 1 day before radiotherapy, 5 weeks after radiotherapy and 1 week after radiotherapy, NTCP was determined 5 weeks after radiotherapy. Univariate analysis and multivariate logistic regression analysis were performed for influencing factors for the secondary RP in the LC patients. The value of serum TGF-β, IL-6 combined with NTCP in early prediction of secondary RP in the LC patients was analyzed by receiver operating characteristic(ROC) curves. RESULTS Among the 125 LC patients, 28(22.40%) had secondary RP, most of whom were grade Ⅱ, and most of them occurred within 1 month after radiotherapy. Univariate analysis and multivariate analysis showed that the radiotherapy dosage and NTCP 5 weeks after radiotherapy were the influencing factors for the secondary RP in the LC patients undergoing radiotherapy(P<0.05). The serum TGF-β during radiotherapy, serum TGF-β after radiotherapy, serum IL-6 before radiotherapy, serum IL-6 during chemotherapy and serum IL-6 after radiotherapy of the RP group were significantly higher than those of the no RP group(P<0.05). ROC curve analysis indicated that serum TGF-β during radiotherapy, serum IL-6 during chemotherapy and NTCP 5 weeks after radiotherapy had the early predictive value, and the value of the joint detection of the three indexes was significantly higher than that of the single detection(P<0.05). CONCLUSION The serum TGF-β, IL-6 combined with NTCP has high value in early prediction of secondary RP in the LC patients undergoing radiotherapy.