Departments of Thoracic Cancer Radiotherapy, Zhongshan People's Hospital, Zhanshan, China.
Xinxiang Medical University, Xinxiang, China.
BMC Pulm Med. 2024 Feb 26;24(1):99. doi: 10.1186/s12890-024-02899-w.
The most common and potentially fatal side effect of thoracic radiation therapy is radiation pneumonitis (RP). Due to the lack of effective treatments, predicting radiation pneumonitis is crucial. This study aimed to develop a dynamic nomogram to accurately predict symptomatic pneumonitis (RP ≥ 2) following thoracic radiotherapy for lung cancer patients.
Data from patients with pathologically diagnosed lung cancer at the Zhongshan People's Hospital Department of Radiotherapy for Thoracic Cancer between January 2017 and June 2022 were retrospectively analyzed. Risk factors for radiation pneumonitis were identified through multivariate logistic regression analysis and utilized to construct a dynamic nomogram. The predictive performance of the nomogram was validated using a bootstrapped concordance index and calibration plots.
Age, smoking index, chemotherapy, and whole lung V5/MLD were identified as significant factors contributing to the accurate prediction of symptomatic pneumonitis. A dynamic nomogram for symptomatic pneumonitis was developed using these risk factors. The area under the curve was 0.89(95% confidence interval 0.83-0.95). The nomogram demonstrated a concordance index of 0.89(95% confidence interval 0.82-0.95) and was well calibrated. Furthermore, the threshold values for high- risk and low- risk were determined to be 154 using the receiver operating curve.
The developed dynamic nomogram offers an accurate and convenient tool for clinical application in predicting the risk of symptomatic pneumonitis in patients with lung cancer undergoing thoracic radiation.
胸部放射治疗最常见且潜在致命的副作用是放射性肺炎（RP）。由于缺乏有效的治疗方法，预测放射性肺炎至关重要。本研究旨在开发一个动态列线图，以准确预测肺癌患者接受胸部放射治疗后出现症状性肺炎（RP≥2）。
回顾性分析 2017 年 1 月至 2022 年 6 月在中山市人民医院胸部癌症放射治疗科经病理诊断为肺癌的患者数据。通过多变量逻辑回归分析确定放射性肺炎的风险因素，并利用这些因素构建动态列线图。通过 bootstrap 一致性指数和校准图验证该列线图的预测性能。
年龄、吸烟指数、化疗和全肺 V5/MLD 被确定为准确预测症状性肺炎的重要因素。使用这些风险因素开发了一个用于症状性肺炎的动态列线图。曲线下面积为 0.89（95%置信区间为 0.83-0.95）。该列线图的一致性指数为 0.89（95%置信区间为 0.82-0.95），且校准良好。此外，使用接收器工作曲线确定了高风险和低风险的阈值分别为 154。
所开发的动态列线图为预测肺癌患者接受胸部放射治疗后出现症状性肺炎风险提供了一种准确、便捷的临床应用工具。
