GNRI和CONUT评分对老年局部晚期NSCLC病人放疗后发生≥2级放射性肺炎的预测价值

Prediction value of GNRI and CONUT score for≥grade 2 radiation pneumonia after radiotherapy in elderly patients with locally advanced non-small cell lung cancer

目的分析老年营养风险指数(GNRI)和营养控制状况(CONUT)评分对老年局部晚期非小细胞肺癌(NSCLC)病人放疗后发生≥2级放射性肺炎(RP)的预测价值。方法选取2019年1月至2022年1月在我院接受放疗的Ⅲ期且年龄≥65岁的老年NSCLC病人81例,放疗后随访3个月,根据病人RP发生情况,将病人分为≥2级RP组(A组,25例)和<2级RP组(B组,56例)。收集病人临床资料和放疗剂量学参数,并计算病人放疗结束时的GNRI和CONUT评分。采用多因素Logistic回归分析老年局部晚期NSCLC病人放疗后发生≥2级RP的影响因素,应用ROC曲线分析GNRI和CONUT评分对≥2级RP的预测价值。结果A组双肺V20(双肺接收>20 Gy剂量照射的肺体积百分比)高于B组(P<0.05);放疗结束时A组GNRI低于B组,CONUT评分高于B组(P<0.05)。多因素Logistic回归分析显示,放疗结束时低GNRI(OR=0.821,95%CI:0.717~0.941)和高CONUT评分(OR=3.653,95%CI:1.944~6.886)是老年局部晚期NSCLC病人放疗后发生≥2级RP的独立危险因素(P<0.01)。ROC曲线分析结果提示,GNRI和CONUT评分预测老年局部晚期NSCLC病人放疗后发生≥2级RP的截断值分别为94.22和4.5分,AUC分别为0.785和0.894;两者联合预测的AUC为0.925,敏感度为0.840,特异度为0.929。结论放疗结束时低GNRI和高CONUT评分是老年局部晚期NSCLC病人放疗后发生≥2级RP的独立危险因素,且两者单独或联合评估对其均具有一定预测价值。

Objective To analyze the predictive value of geriatric nutritional risk index(GNRI)and controlling nutritional status(CONUT)score for≥grade 2 radiation pneumonia(RP)after radiotherapy in the elderly patients with locally advanced non-small cell lung cancer(NSCLC).Methods A total of 81 elderly patients with stageⅢNSCLC aged≥65 years who received radiotherapy in our hospital from January 2019 to January 2022 were enrolled in this study,and they were followed up for 3 months after radiotherapy.According to the occurrence of RP,the patients were divided into≥grade 2 RP group(group A,25 cases)and<grade 2 group(group B,56 cases).The clinical data and radiotherapy dosimetry parameters of the patients were collected.GNRI and CONUT scores at the end of radiotherapy were evaluated and compared between the two groups.Multivariate Logistic regression analysis was used to explore the influencing factors of≥grade 2 RP after radiotherapy,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of GNRI and CONUT scores for≥grade 2 RP after radiotherapy in the elderly patients with locally advanced NSCLC.Results The dosimetry comparison between the two groups showed that V20(percentage of lung volume receiving radiation dose>20 Gy in both lungs)in group A was higher than that in group B(P<0.05).At the end of radiotherapy,GNRI was lower while the CONUT score was higher in group A than that in group B(P<0.05).Multivariate Logistic regression showed that low GNRI and high CONUT score at the end of radiotherapy were independent risk factors for≥grade 2 RP after radiotherapy in the elderly patients with locally advanced NSCLC.ROC curve analysis showed that the cut-off value of GNRI and CONUT score in predicting≥grade 2 RP after radiotherapy was 94.22 and 4.5,with an area under the curve(AUC)of 0.785 and 0.894 respectively.The AUC of the combination of GNRI and CONUT score in predicting≥grade 2 RP after radiotherapy was 0.925,and the sensitivity was 0.840,and the specificity was 0.929.Conclusions Low GNRI and high CONUT score at the end of radiotherapy are independent risk factors for≥grade 2 RP after radiotherapy in the elderly patients with locally advanced NSCLC,and combination of GNRI and CONUT score have high predictive value.