Department of Radiation Oncology, First Affiliated Hospital of Soochow University, Suzhou, 215000, China.
Radiat Oncol. 2023 Aug 29;18(1):143. doi: 10.1186/s13014-023-02304-6.
We conducted a retrospective statistical analysis of clinical and physical dosimetric factors of lung cancer patients who had previously undergone lung and/or mediastinal radiotherapy and died of or survived severe acute radiation pneumonitis (SARP). Our study was the first to reveal the heterogeneity in clinical factors, physical dosimetric factors, and SARP onset time that determined the clinical outcomes of lung cancer patients who developed SARP.
The clinical characteristics, physical dosimetry factors, and SARP onset time of deceased and surviving patients were retrospectively analyzed. SPSS 20.0 was used for data analysis. Student's t-test was used for intergroup comparison, and a Mann-Whitney U test was used for data with skewed distribution. Qualitative data were represented using frequencies (%), and Fisher's exact test or χ test was used for intergroup comparison of nonparametric data. Binary logistic analysis was used for univariate and multivariate analyses. Differences with a P < 0.05 were considered statistically significant.
Univariate analysis revealed that the potential predictors of SARP death were as follows: ipsilateral lung V5 and V30, contralateral lung V5, V10, and V30, total lung V5, V10, and V30, mean lung dose, mean heart dose, and maximum spinal cord dose. Multivariate analysis showed that ipsilateral lung V5 and total lung V5 were predictors that determined the final outcome of SARP patients. In addition, we analyzed the time from the completion of radiotherapy to SARP onset, and found significant difference between the two groups.
There was no decisive correlation between clinical characteristics and SARP outcome (i.e., death or survival) in lung radiotherapy patients. Ipsilateral lung V5 and total lung V5 were independent predictors of death in SARP patients.
我们对既往接受过肺和/或纵隔放疗且因严重急性放射性肺炎（SARP）死亡或存活的肺癌患者的临床和物理剂量学因素进行回顾性统计分析。本研究首次揭示了决定发生 SARP 的肺癌患者临床结局的临床因素、物理剂量学因素和 SARP 发病时间的异质性。
回顾性分析死亡和存活患者的临床特征、物理剂量学因素和 SARP 发病时间。采用 SPSS 20.0 进行数据分析。组间比较采用 Student's t 检验，偏态分布数据采用 Mann-Whitney U 检验。定性数据用频率（%）表示，非参数数据的组间比较采用 Fisher 确切检验或 χ 检验。单因素和多因素分析采用二元逻辑分析。差异有统计学意义的 P 值<0.05。
单因素分析显示，SARP 死亡的潜在预测因素如下：同侧肺 V5 和 V30、对侧肺 V5、V10 和 V30、全肺 V5、V10 和 V30、平均肺剂量、平均心脏剂量和最大脊髓剂量。多因素分析显示，同侧肺 V5 和全肺 V5 是决定 SARP 患者最终结局的预测因素。此外，我们分析了从放疗结束到 SARP 发病的时间，发现两组之间存在显著差异。
在肺癌放疗患者中，临床特征与 SARP 结局（即死亡或存活）之间没有决定性的相关性。同侧肺 V5 和全肺 V5 是 SARP 患者死亡的独立预测因素。
