食管癌患者发生放射性食管炎风险列线图预测模型的构建及验证

Construction and verification of risk prediction model of radiation esophagitis in patients with esophageal cancer

目的构建食管癌患者发生放射性食管炎风险列线图预测模型。方法选取2017年10月至2022年7月在中国医学科学院北京协和医学院肿瘤医院特需病房进行放疗的94例食管癌患者作为研究对象,根据随访是否发生放射性食管炎进行分组,其中放射性食管炎组53例,非放射性食管炎组41例,采用多因素Logistic回归分析筛选食管癌患者发生放射性食管炎的独立危险因素,在此基础上建立列线图模型。结果放射性食管炎组与非放射性食管炎组在手术情况、营养治疗情况、肿瘤位置及TNM分期和低蛋白血症的差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示未手术(OR=3.152,95%CI=1.070~4.471)、未营养治疗(OR=2.330,95%CI=1.268~3.544)、肿瘤位置为颈段(OR=3.380,95%CI=1.197~10.551)及TNM分期≥Ⅲ期(OR=2.625,95%CI=1.387~5.554)为放射性食管炎的独立危险因素。依据多因素Logistic回归分析结果建立列线图预测模型,采用受试者操作特征曲线(ROC)评估放射性食管炎预测效能,结果发现曲线下面积(AUC)为0.730。结论食管癌患者接受放疗后会有部分患者发生放射性食管炎,未手术、未营养治疗、肿瘤位置为颈段及TNM分期≥Ⅲ期为放射性食管炎的独立危险因素,基于以上危险因素建立的定量列线图预测模型对放射性食管炎有良好的效能及临床应用价值。

Objective To explore the establishment of a risk nomogram prediction model for radiation esophagitis in patients with esophageal cancer.Method A total of 94 patients with esophageal cancer who underwent radiation therapy in Department of VIP Medical Services of the Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from October 2017to July 2022 were selected as the study objects.They were divided into two groups according to whether radiation esophagitis occurred during follow-up,including 53 patients in the radiation esophagitis group and 41 patients in the non-radiation esophagitis group.Multivariate Logistic regression analysis was used to screen the independent risk factors of radiation esophagitis in patients with esophageal cancer,and the nomogram model was established on this basis.Result There were statistically significant differences in surgical conditions,nutritional support,tumor location,TNM stage and hypoproteinemia between radiation esophagitis group and non-radiation esophagitis group(P<0.05).Multivariate Logistic regression analysis showed no surgery(OR=3.152,95%CI=1.070-4.471),no nutritional support(OR=2.330,95%CI=1.268-3.544),tumor location in the neck(OR=3.380,95%CI=1.197-10.551)and TNM stage≥Ⅲ(OR=2.625,95%CI=1.387-5.554)were independent risk factors for radiation esophagitis.Based on the results of multivariate Logistic regression analysis,a nomogram prediction model was established,and receiver operating characteristic curve(ROC)was used to evaluate the prediction efficiency of radiation esophagitis.The results showed that the area under the curve(AUC)was 0.730.Conclusion Radiation esophagitis may occur in some patients with esophageal cancer after radiotherapy.The independent risk factors for radiation esophagitis include no operation,no nutritional support,neck location of the tumor and TNM stage≥Ⅲ.The establishment of a quantitative nomogram prediction model based on the above risk factors has good efficacy and clinical application value.