Cai Guoxin, Liang Shuai, Li Chuanbao, Meng Xue, Yu Jinming
Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China.
Front Oncol. 2020 Jan 24;9:1511. doi: 10.3389/fonc.2019.01511. eCollection 2019.
To assess the association between left ventricular (LV) systolic and diastolic dysfunction and grade ≥2 radiation pneumonitis (RP) for locally advanced lung cancer patients receiving definitive radiotherapy. A retrospective analysis was carried out for 260 lung cancer patients treated with definitive radiotherapy between 2015 and 2017. RP was evaluated according to Radiation Therapy Oncology Group (RTOG) toxicity criteria. Logistic regression analysis, 10-fold cross validation, and external validation were performed. The prediction model's discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration of the model was assessed by the Hosmer-Lemeshow test and the calibration curve. Within the first 6 months after radiotherapy, 70 patients (26.9%) developed grade ≥2 RP. Reduced left ventricular ejection fraction (LVEF) before radiotherapy was detected in 53 patients (20.4%). The odds ratio (OR) of developing RP for patients with LVEF <50% was 3.42 [ < 0.001, 95% confidence interval (CI), 1.85-6.32]. Multivariate analysis showed that forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), LVEF, Eastern Cooperative Oncology Group (ECOG) performance status, chemotherapy, and mean lung dose (MLD) were significantly associated with grade ≥2 RP. The AUC of a model including the above five variables was 0.835 (95% CI, 0.778-0.891) on 10-fold cross validation and 0.742 (95% CI, 0.633-0.851) on the external validation set. The -value for the Hosmer-Lemeshow test was 0.656 on 10-fold cross validation and 0.534 on the external validation set. LV systolic dysfunction is a possible independent risk factor for RP in locally advanced lung cancer patients receiving definitive radiotherapy.
评估接受根治性放疗的局部晚期肺癌患者左心室（LV）收缩和舒张功能障碍与≥2级放射性肺炎（RP）之间的关联。对2015年至2017年间接受根治性放疗的260例肺癌患者进行回顾性分析。根据放射治疗肿瘤学组（RTOG）毒性标准评估RP。进行逻辑回归分析、10倍交叉验证和外部验证。使用受试者操作特征曲线（AUC）下的面积评估预测模型的判别性能，并通过Hosmer-Lemeshow检验和校准曲线评估模型的校准。在放疗后的前6个月内，70例患者（26.9%）发生≥2级RP。53例患者（20.4%）在放疗前检测到左心室射血分数（LVEF）降低。LVEF<50%的患者发生RP的比值比（OR）为3.42[<0.001，95%置信区间（CI），1.85-6.32]。多因素分析显示，第1秒用力呼气量/用力肺活量（FEV1/FVC）、LVEF、东部肿瘤协作组（ECOG）体能状态、化疗和平均肺剂量（MLD）与≥2级RP显著相关。在10倍交叉验证中，包含上述五个变量的模型的AUC为0.835（95%CI，0.778-0.891），在外部验证集中为0.742（95%CI，0.633-0.851）。在10倍交叉验证中，Hosmer-Lemeshow检验的P值为0.656，在外部验证集中为0.534。左心室收缩功能障碍是接受根治性放疗的局部晚期肺癌患者发生RP的一个可能的独立危险因素。
