Department of Neurology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang Xi Road, Guangzhou, China.
Radiotherapeutic Department, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Behav Neurol. 2022 Aug 19;2022:6307804. doi: 10.1155/2022/6307804. eCollection 2022.
Radiotherapy for patients with head and neck cancers raises their risk of aspiration pneumonia-related death. We aimed to develop and validate a model to predict radiation-associated aspiration pneumonia (RAP) among patients with dysphagia after radiotherapy for nasopharyngeal carcinoma (NPC).
A total of 453 dysphagic patients with NPC were retrospectively recruited from Sun Yat-Sen Memorial Hospital from January 2012 to January 2018. Patients were randomly divided into training cohort ( = 302) and internal validation cohort ( = 151) at a ratio of 2 : 1. The concordance index (C-index) and calibration curve were used to evaluate the accuracy and discriminative ability of this model. Moreover, decision curve analysis was performed to evaluate the net clinical benefit. The results were externally validated in 203 dysphagic patients from the First People's Hospital of Foshan.
Derived from multivariable analysis of the training cohort, four independent factors were introduced to predict RAP, including Kubota water drinking test grades, the maximum radiation dose of lymph node gross tumor volume (Dmax of the GTVnd), neutrophil count, and erythrocyte sedimentation rate (ESR). The nomogram showed favorable calibration and discrimination regarding the training cohort, with a C-index of 0.749 (95% confidence interval (CI), 0.681 to 0.817), which was confirmed by the internal validation cohort (C-index 0.743; 95% CI, 0.669 to 0.818) and the external validation cohort (C-index 0.722; 95% CI, 0.606 to 0.838).
Our study established and validated a simple nomogram for RAP among patients with dysphagia after radiotherapy for NPC.
头颈部癌症患者的放射治疗会增加其与吸入性肺炎相关的死亡风险。我们旨在开发和验证一种模型，以预测接受放射治疗后吞咽困难的鼻咽癌（NPC）患者的放射性肺炎（RAP）。
回顾性招募了来自中山大学孙逸仙纪念医院 2012 年 1 月至 2018 年 1 月期间的 453 例 NPC 吞咽困难患者。患者以 2：1 的比例随机分为训练队列（n = 302）和内部验证队列（n = 151）。一致性指数（C-index）和校准曲线用于评估该模型的准确性和区分能力。此外，进行决策曲线分析以评估净临床获益。该结果在佛山市第一人民医院的 203 例吞咽困难患者中进行了外部验证。
在训练队列的多变量分析中，引入了四个独立因素来预测 RAP，包括 Kubota 饮水试验分级、淋巴结大体肿瘤体积（GTVnd）的最大照射剂量（Dmax）、中性粒细胞计数和红细胞沉降率（ESR）。该列线图在训练队列中显示出良好的校准和区分能力，C 指数为 0.749（95%置信区间（CI），0.681 至 0.817），这在内部验证队列（C 指数 0.743；95%CI，0.669 至 0.818）和外部验证队列（C 指数 0.722；95%CI，0.606 至 0.838）中得到了验证。
我们的研究建立并验证了一种用于 NPC 放射治疗后吞咽困难患者 RAP 的简单列线图。
