Hu Jing, Shi Qianjin, Gong Xiaoqin, You Tao, Dai Chunhua, Chen Fei
Department of Oncology, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu, China.
Department of Oncology, Siyang Hospital, Suqian, Jiangsu, China.
Front Oncol. 2024 Nov 29;14:1453837. doi: 10.3389/fonc.2024.1453837. eCollection 2024.
Acute radiation enteritis is one of the most common complications of radiotherapy for patients with cervical cancer. This study aims to investigate the effect of acute radiation enteritis on the prognosis of patients with cervical cancer receiving radiotherapy and to establish a nomogram predicting the patients' overall survival (OS).
The clinical data of 288 patients with cervical cancer who were admitted to our department from 2014 to 2020 were retrospectively analyzed, and the survival of patients were followed up. The Kaplan-Meier method was used to calculate the survival rate and for univariate analysis, and the Cox regression model was used for multivariate prognostic analysis. A nomogram survival prediction model was established based on independent risk factors, and the concordance index (C-index), receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive accuracy of the model. The clinical applicability of the model was assessed by the decision curve. External validation of the nomogram prediction model was performed in 74 patients admitted to our hospital from 2020 to 2021.
60 patients (20.8%) developed grade 2 or higher acute radiation enteritis. The 1-, 3-, and 5-year OS rates were 94.4%, 80.9%, and 77.4%, respectively. Multivariate Cox regression analysis showed that: Age ≥ 60 years, diabetes/hypertension, anemia, FIGO stage III-IV, poor differentiation, pelvic lymph node metastasis, NLR ≥ 2.54 and grade 2 or higher acute radiation enteritis were independent risk factors for OS in cervical cancer patients undergoing radiotherapy ( < 0.05). The C-index of OS nomogram model was 0.815 (95% CI: 0.766-0.864). The AUC of 3-year and 5-year OS were 0.849 (95%CI: 0.789-0.909) and 0.840 (95%CI: 0.782-0.899), respectively. The AUC value of 3-year OS in the external validation set was 0.779 (95%CI: 0.635-0.922). The calibration curve showed that the model was well calibrated, and the decision curve verified the clinical applicability of the constructed nomogram.
This study established an accurate predicting nomogram based on independent prognostic factors in cervical cancer patients receiving radiotherapy, and patients with grade 2 or higher acute radiation enteritis should be paid more attention to in clinical practice.
急性放射性肠炎是宫颈癌患者放疗最常见的并发症之一。本研究旨在探讨急性放射性肠炎对接受放疗的宫颈癌患者预后的影响，并建立预测患者总生存期（OS）的列线图。
回顾性分析2014年至2020年收治于我科的288例宫颈癌患者的临床资料，并对患者生存情况进行随访。采用Kaplan-Meier法计算生存率并进行单因素分析，采用Cox回归模型进行多因素预后分析。基于独立危险因素建立列线图生存预测模型，采用一致性指数（C-index）、受试者工作特征（ROC）曲线和校准曲线评估模型的预测准确性。通过决策曲线评估模型的临床适用性。对2020年至2021年我院收治的74例患者进行列线图预测模型的外部验证。
60例患者（20.8%）发生2级或更高等级的急性放射性肠炎。1年、3年和5年总生存率分别为94.4%、80.9%和77.4%。多因素Cox回归分析显示：年龄≥60岁、糖尿病/高血压、贫血、国际妇产科联盟（FIGO）分期III-IV期、低分化、盆腔淋巴结转移、中性粒细胞与淋巴细胞比值（NLR）≥2.54以及2级或更高等级的急性放射性肠炎是接受放疗的宫颈癌患者总生存期的独立危险因素（P<0.05）。总生存期列线图模型的C-index为0.815（95%置信区间：0.766-0.864）。3年和5年总生存期的曲线下面积（AUC）分别为0.849（95%置信区间：0.789-0.909）和0.840（95%置信区间：0.782-0.899）。外部验证集中3年总生存期的AUC值为0.779（95%置信区间：0.635-0.922）。校准曲线显示模型校准良好，决策曲线验证了所构建列线图的临床适用性。
本研究基于接受放疗的宫颈癌患者的独立预后因素建立了准确的预测列线图，临床实践中应更加关注发生2级或更高等级急性放射性肠炎的患者。
