基于 MRI 的评分系统对鼻咽癌患者放射性鼻窦炎的临床评估。

Clinical evaluation of radiation-induced sinusitis by MRI-based scoring system in nasopharyngeal carcinoma patients.

机构信息

Department of Otolaryngology, Head and Neck Surgery, General Hospital of Southern Theatre Command of PLA, Guangzhou, 510010, China.

The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.

出版信息

Radiat Oncol. 2023 Sep 18;18(1):153. doi: 10.1186/s13014-023-02331-3.

DOI:10.1186/s13014-023-02331-3

PMID:37723540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10508027/

Abstract

OBJECTIVE

To explore the application of magnetic resonance imaging (MRI) in the evaluation of radiation-induced sinusitis (RIS), MRI-based scoring system was used to evaluate the development regularity, characteristics and influencing factors of RIS in nasopharyngeal carcinoma (NPC) patients.

PATIENTS AND METHODS

A retrospective analysis was performed by collecting the clinical and MRI data of 346 NPC patients to analyze the characteristics and prognosis of RIS. The predictive model was constructed according to the influencing factors of RIS.

RESULTS

(1) In the 2-year follow-up after radiotherapy (RT), there was significant change in L-M score in both groups of NPC patients (sinusitis before RT group: p = 0.000 vs. non-sinusitis before RT group: p = 0.000). After 6 months of RT, the L-M scores of the two groups tended to plateau (sinusitis before RT group: p = 0.311 vs. non-sinusitis before RT group: p = 0.469). (2) The prevalence of sinusitis in two groups of NPC patients (without or with sinusitis before RT) was 83% vs. 93%, 91% vs. 99%, 94% vs. 98% at 1, 6 and 24 months after RT, respectively. (3) In the patients without sinusitis before RT, the incidence of sinusitis in maxillary and anterior/posterior ethmoid, sphenoid and frontal sinuses was 87.1%, 90.0%/87.1%, 49.5%, 11.8% respectively, 1 month after RT. (4) A regression model was established according to the univariate and multivariate analysis of the factors related to RIS (smoking history: p = 0.000, time after RT: p = 0.008 and TNM staging: p = 0.040).

CONCLUSION

(1) RIS is a common complication in NPC patients after RT. This disorder progressed within 6 months after RT, stabilized and persisted within 6 months to 2 years. There is a high incidence of maxillary sinus and ethmoid sinus inflammation in NPC patients after RT. (2) Smoking history, time after RT and TNM staging were significant independent risk factors for RIS. (3) The intervention of the risk factors in the model may prevent or reduce the occurrence of RIS in NPC patients.

摘要

目的

探讨磁共振成像（MRI）在放射性鼻窦炎（RIS）评估中的应用，采用 MRI 评分系统评估鼻咽癌（NPC）患者 RIS 的发展规律、特征及影响因素。

方法

回顾性分析 346 例 NPC 患者的临床和 MRI 资料，分析 RIS 的特点及预后，根据 RIS 的影响因素构建预测模型。

结果

（1）放疗后 2 年随访，两组 NPC 患者 L-M 评分均有显著变化（放疗前有鼻窦炎组：p=0.000；放疗前无鼻窦炎组：p=0.000）。放疗后 6 个月，两组 L-M 评分趋于平稳（放疗前有鼻窦炎组：p=0.311；放疗前无鼻窦炎组：p=0.469）。（2）两组 NPC 患者（放疗前有或无鼻窦炎）放疗后 1、6、24 个月的鼻窦炎发生率分别为 83%比 93%、91%比 99%、94%比 98%。（3）放疗前无鼻窦炎的患者，上颌窦、前/后筛窦、蝶窦和额窦的鼻窦炎发生率分别为 87.1%、90.0%/87.1%、49.5%、11.8%，均在放疗后 1 个月。（4）根据 RIS 相关因素的单因素和多因素分析，建立了回归模型（吸烟史：p=0.000；放疗后时间：p=0.008；TNM 分期：p=0.040）。

结论

（1）RIS 是 NPC 患者放疗后的常见并发症。这种疾病在放疗后 6 个月内进展，在 6 个月至 2 年内稳定并持续存在。NPC 患者放疗后上颌窦和筛窦炎症发生率较高。（2）吸烟史、放疗后时间和 TNM 分期是 RIS 的显著独立危险因素。（3）模型中危险因素的干预可能预防或减少 NPC 患者 RIS 的发生。