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放疗与食管鳞癌胸腰椎骨折的相关性：一项回顾性队列研究。

Association of radiotherapy with thoracic vertebral fractures in esophageal squamous cell carcinoma: A retrospective cohort study.

机构信息

Department of Radiology, Affiliated Hospital of North Sichuan Medical College, and Sichuan Key Laboratory of Medical Imaging, Sichuan, China.

Department of Radiology, The second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

出版信息

Medicine (Baltimore). 2023 Sep 29;102(39):e35304. doi: 10.1097/MD.0000000000035304.

DOI:10.1097/MD.0000000000035304
PMID:37773852
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10545250/
Abstract

To investigate the association between radiotherapy (RT) and thoracic vertebral fractures in esophageal squamous cell carcinoma (ESCC) and explore the risk factors of thoracic vertebral fracture in ESCC who underwent RT. This retrospective cohort study including 602 consecutive ESCC patients examined the association between RT and thoracic vertebral fractures using multivariable Cox proportional hazard models and relevant risk factors of thoracic vertebral fractures based on clinical and RT parameters in patients with ESCC. Followed for a median follow-up of 24 months, 54 patients had thoracic vertebral fractures. The multivariable analysis revealed RT as an independent risk factor after adjusting for clinical risk factors. Univariable analyses associated a 5-Gy increase in vertebral dose to single vertebrae and a 1-time increase in RT fraction with higher risk of vertebral fracture. Adding RT factors (vertebral dose and fraction) and mean vertebral hounsfield unit to the Cox models containing conventional clinical risk factors significantly improved the χ2 value for predicting vertebral fractures (all P < .001). This study revealed RT, as well as increased vertebral dose and RT fractions, as a significant, consistent, and strong vertebral fracture predictor in ESCC. Combined vertebral dose, RT fractions, and vertebral hounsfield unit provided optimal risk stratification for ESCC patients.

摘要

为了研究放疗（RT）与食管鳞状细胞癌（ESCC）患者胸椎骨折之间的关联，并探讨接受 RT 的 ESCC 患者胸椎骨折的危险因素。本回顾性队列研究纳入了 602 例连续的 ESCC 患者，使用多变量 Cox 比例风险模型来研究 RT 与胸椎骨折之间的关联，并基于 ESCC 患者的临床和 RT 参数，探讨了与胸椎骨折相关的危险因素。中位随访时间为 24 个月，54 例患者发生了胸椎骨折。多变量分析显示，在校正了临床危险因素后，RT 是一个独立的危险因素。单变量分析表明，每增加 5Gy 的椎体剂量和 1 次 RT 分割，都会增加椎体骨折的风险。将 RT 因素（椎体剂量和分割）和平均椎体 Hounsfield 单位添加到包含常规临床危险因素的 Cox 模型中，显著提高了预测椎体骨折的 χ2 值（均 P<0.001）。本研究表明，RT 以及增加的椎体剂量和 RT 分割，是 ESCC 患者发生椎体骨折的一个显著、一致和强烈的预测因素。联合椎体剂量、RT 分割和椎体 Hounsfield 单位可为 ESCC 患者提供最佳的风险分层。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/f57f446c8361/medi-102-e35304-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/50e415c0a80d/medi-102-e35304-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/324382a4db9f/medi-102-e35304-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/1feed0591637/medi-102-e35304-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/18ae2a572f5c/medi-102-e35304-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/29c8638c4a55/medi-102-e35304-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/f57f446c8361/medi-102-e35304-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/50e415c0a80d/medi-102-e35304-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/324382a4db9f/medi-102-e35304-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/1feed0591637/medi-102-e35304-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/18ae2a572f5c/medi-102-e35304-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/29c8638c4a55/medi-102-e35304-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/55a6/10545250/f57f446c8361/medi-102-e35304-g006.jpg

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Acta Oncol. 2021 May;60(5):627-634. doi: 10.1080/0284186X.2021.1902564. Epub 2021 Apr 1.
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