State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Esophageal Cancer Institute, Guangzhou, China.
Department of Nasopharyngeal Carcinoma, Sun Yat-Sen University Cancer Center, Guangzhou, China.
Esophagus. 2021 Oct;18(4):861-871. doi: 10.1007/s10388-021-00860-y. Epub 2021 Jun 15.
To develop and validate a nomogram for the prediction of symptomatic radiation pneumonitis (RP) in patients with esophageal squamous cell carcinoma (ESCC) who received definitive concurrent chemoradiotherapy.
Clinical factors, dose-volume histogram parameters, and pulmonary function parameters were collected from 402 ESCC patients between 2010 and 2017, including 321 patients in the primary cohort and 81 in the validation cohort. The end-point was the occurrence of symptomatic RP (grade ≥ 2) within the first 12 months after radiotherapy. Univariate and multivariate logistic regression analyses were applied to evaluate the predictive value of each factor for RP. A prediction model was generated in the primary cohort, which was internally validated to assess its performance.
In the primary cohort, 31 patients (9.7%) experienced symptomatic RP. Based on logistic regression model, patients with larger planning target volumes (PTVs) or higher lung V had a higher predictive risk of RP, whereas the overall risk was substantially higher for three-dimensional conformal radiotherapy (3DCRT) than intensity-modulated radiotherapy. On multivariate analysis, independent predictive factors for RP were smoking history (P = 0.035), radiotherapy modality (P < 0.001), PTV (P = 0.039), and lung V (P < 0.001), which were incorporated into the nomogram. The areas under the receiver operating characteristic curve of the nomogram in the primary and validation cohorts were 0.772 and 0.900, respectively, which were superior to each predictor alone.
Non-smoking status, 3DCRT, lung V (> 27.5%), and PTV (≥ 713.0 cc) were significantly associated with a higher risk of RP. A nomogram was built with satisfactory prediction ability.
为了开发和验证一种列线图，用于预测接受根治性同期放化疗的食管鳞癌（ESCC）患者出现症状性放射性肺炎（RP）的风险。
从 2010 年至 2017 年，共收集了 402 例 ESCC 患者的临床因素、剂量-体积直方图参数和肺功能参数，其中包括原队列中的 321 例患者和验证队列中的 81 例患者。终点事件为放疗后 12 个月内发生症状性 RP（≥2 级）。采用单因素和多因素 logistic 回归分析评估每个因素对 RP 的预测价值。在原队列中生成预测模型，并进行内部验证以评估其性能。
在原队列中，有 31 例（9.7%）患者出现症状性 RP。基于 logistic 回归模型，PTV 较大或肺 V 较高的患者发生 RP 的预测风险较高，而三维适形放疗（3DCRT）的总体风险明显高于调强放疗。多因素分析显示，RP 的独立预测因素为吸烟史（P=0.035）、放疗方式（P<0.001）、PTV（P=0.039）和肺 V（P<0.001），这些因素被纳入列线图。在原队列和验证队列中，列线图的受试者工作特征曲线下面积分别为 0.772 和 0.900，均优于各单一预测因素。
不吸烟状态、3DCRT、肺 V（>27.5%）和 PTV（≥713.0cc）与 RP 风险增加显著相关。构建的列线图具有良好的预测能力。
