鼻咽癌根治性放疗后获得性鼻腔狭窄和闭锁的正常组织并发症概率模型的建立与验证

Development and validation of a normal tissue complication probability model for acquired nasal cavity stenosis and atresia after radical radiotherapy for nasopharyngeal carcinoma.

作者信息

Yan Jin-Jie, Guo Shan-Shan, Lin Da-Feng, Liu Li-Ting, Liu Sai-Lan, Xiao Bei-Bei, Yang Jin-Hao, Wen Dong-Xiang, Yang Zhen-Chong, Liang Yu-Jing, Tang Qing-Nan, Lin Chao, Li Xiao-Yun, Sun Xue-Song, Li Ji-Bin, Tang Lin-Quan, Chen Qiu-Yan, Mai Hai-Qiang

机构信息

Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.

Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.

出版信息

Radiother Oncol. 2021 Jul;160:9-17. doi: 10.1016/j.radonc.2021.03.040. Epub 2021 Apr 9.

DOI:10.1016/j.radonc.2021.03.040

PMID:33839205

Abstract

PURPOSE

Curative radiotherapy for nasopharyngeal carcinoma (NPC) can lead to acquired nasal cavity stenosis and atresia (ANCSA). As the first study to investigate risk factors of ANCSA in a large cohort of NPC patients, this article aims to develop and validate a multivariate normal tissue complication probability (NTCP) model to predict the development of ANCSA and to establish a nomogram for clinical use.

METHODS AND MATERIALS

The retrospective cohort was comprised of 548 NPC patients treated with radical radiotherapy. The cohort was randomly divided into training and validation groups. Least absolute shrinkage and selection operator regression was performed for variable selection from the clinical and dosimetric characteristics in the training group. A multivariate NTCP model and a nomogram were established for the prediction of ANCSA development. Discrimination and calibration were tested using receiver operating characteristic (ROC) curves and calibration tests, respectively, for both groups.

RESULTS

ANCSA was observed in 132 (24.1%) of 548 patients with NPC who underwent radical radiotherapy. The median time to ANCSA detection after treatment was 2.8 months (range, 0.0-57.7 months). Five potential predictors, including choanal invasion, low white blood cell count, high C-reactive protein level, high serum amyloid A level, and high V70Gy of the nasal cavity, were selected to develop the NTCP model based on 365 patients in the training group. The model had a fairly good discriminative power according to the ROC analysis in both the training (area under ROC curve = 0.79, 95%CI: 0.73-0.84) and validation (0.73, 0.64-0.82) groups. The calibration power was tested using the calibration test in the training (E-max = 0.069, E-avg = 0.015, p = 0.977) and validation (E-max = 0.057, E-avg = 0.032, p = 0.747) groups.

CONCLUSIONS

We developed and successfully validated an NTCP model for early prediction of ANCSA in patients with NPC after radical radiotherapy. This could help clinicians assess the risk of ANCSA before the initiation of follow-ups and ensure appropriate and timely management of this complication.

摘要

目的

鼻咽癌（NPC）的根治性放疗可导致获得性鼻腔狭窄和闭锁（ANCSA）。作为第一项在大量NPC患者队列中研究ANCSA危险因素的研究，本文旨在开发并验证一个多变量正常组织并发症概率（NTCP）模型，以预测ANCSA的发生，并建立一个用于临床的列线图。

方法和材料

回顾性队列包括548例接受根治性放疗的NPC患者。该队列被随机分为训练组和验证组。在训练组中，采用最小绝对收缩和选择算子回归从临床和剂量学特征中进行变量选择。建立了一个多变量NTCP模型和一个列线图来预测ANCSA的发生。分别使用受试者操作特征（ROC）曲线和校准测试对两组进行区分度和校准测试。

结果

在548例接受根治性放疗的NPC患者中，有132例（24.1%）出现了ANCSA。治疗后检测到ANCSA的中位时间为2.8个月（范围：0.0 - 57.7个月）。基于训练组中的365例患者，选择了五个潜在预测因素，包括后鼻孔侵犯、低白细胞计数、高C反应蛋白水平、高血清淀粉样蛋白A水平以及鼻腔高V70Gy，来开发NTCP模型。根据ROC分析，该模型在训练组（ROC曲线下面积 = 0.79，95%CI：0.73 - 0.84）和验证组（0.73，0.64 - 0.82）中均具有相当好的区分能力。使用校准测试在训练组（E - max = 0.069，E - avg = 0.015，p = 0.977）和验证组（E - max = 0.057，E - avg = 0.032，p = 0.747）中测试了校准能力。