乳腺癌保乳术后大分割放疗致急性放射性皮肤损伤的影响因素分析及风险预测模型构建

Analysis of influencing factors and construction of risk prediction model for acute radiation-induced skin injury caused by hypofractionated radiotherapy after breast-conserving surgery

目的分析乳腺癌保乳术后大分割放疗致急性放射性皮肤损伤的影响因素,并构建其风险预测模型。方法选择2020年10月至2022年9月于唐山市人民医院接受保乳切除术的170例乳腺癌患者的临床资料,将170例患者按7∶3分为模型组(119例)和验证组(51例)。根据急性放射性皮肤损伤发生情况,将模型组患者进一步分为损伤组(89例)和无损伤组(30例)。比较损伤组和无损伤组的临床资料,采用多因素logistic回归分析其危险因素,并构建列线图风险预测模型。结果多因素logistic回归分析结果显示,体质量指数(BMI)≥28 kg/m^(2),有糖尿病史,肿瘤T分期为T 2期,三阴性乳腺癌,放疗形式为序贯瘤床电子线补量放疗,以及较高的CD4^(+)T淋巴细胞凋亡率及血红蛋白(Hb)水平是患者发生急性放射性皮肤损伤的独立危险因素(P<0.05)。根据这些指标构建列线图风险预测模型。受试者工作特征(ROC)曲线分析结果显示,对于模型组,该模型预测急性放射性皮肤损伤发生风险的曲线下面积(AUC)为0.942(95%CI:0.890~0.974),灵敏度为97.14%,特异度为86.24%;对于验证组,该模型预测急性放射性皮肤损伤发生风险的AUC为0.926(95%CI:0.880~0.966),灵敏度为86.36%,特异度为90.40%。结论BMI、糖尿病史、肿瘤T分期、三阴性乳腺癌、放疗形式、CD4^(+)T淋巴细胞凋亡率及Hb水平均是乳腺癌保乳术后大分割放疗致急性放射性皮肤损伤的影响因素,以此为基础构建的列线图风险预测模型具有较好的临床应用价值。

Objective To analyze the influencing factors of acute radiation-induced skin injury caused by hypofractionated radiotherapy after breast-conserving surgery,and to construct its risk prediction model.Methods The clinical data of 170 patients with breast cancer who underwent breast-conserving surgery for breast cancer in Tangshan People′s Hospital from October 2020 to September 2022 were selected,and the 170 patients were divided into model group(119 cases)and validation group(51 cases)according to a ratio of 7∶3.According to the occurrence of acute radiation-induced skin injury,the patients of the model group were further divided into injury group(89 cases)and non-injury group(30 cases).The clinical data were compared between the injury group and the non-injury group,and the risk factors were analyzed using multivariate logistic regression,and the risk prediction model was constructed using nomogram.Results The results of multivariate logistic regression analysis showed that body mass index(BMI)≥28 kg/m^(2),history of diabetes,T stage of tumor at T 2,triple negative breast cancer,the form of radiotherapy being sequential tumor bed electron line supplement radiotherapy,higher CD4^(+)T lymphocyte apoptosis rate and hemoglobin(Hb)level were independent risk factors for the patients with acute radiation-induced skin injury(P<0.05).Based on these indicators,a nomogram risk prediction model was constructed.The results of receiver operating characteristic(ROC)curve analysis showed that the area under the curve(AUC)for predicting the risk of acute radiation-induced skin injury was 0.942(95%CI:0.890-0.974)for the model group,with the sensitivity of 97.14%and the specificity of 86.24%,and AUC for predicting the risk of acute radiation-induced skin injury was 0.926(95%CI:0.880-0.966)for the validation group,with the sensitivity of 86.36%,and the specificity of 90.40%.Conclusion BMI,history of diabetes,T stage of tumor,triple negative breast cancer,the form of radiotherapy,CD4^(+)T lymphocyte apoptosis rate and Hb level are the factors affecting acute radiation-induced skin injury caused by hypofractionated radiotherapy after breast-conserving surgery.The risk prediction model of nomogram constructed based on this basis has good clinical application value.