在一个国际队列中对头颈部癌患者的一套全面的正常组织并发症概率模型进行评估。
Evaluation of a comprehensive set of normal tissue complication probability models for patients with head and neck cancer in an international cohort.
作者信息
de Vette Suzanne P M, van Rijn-Dekker Maria I, Van den Bosch Lisa, Keijzer Kylie, Neh Hendrike, Chu Hung, Li Yan, Frederiks Mark L, van der Laan Hans Paul, Heukelom Jolien, van Luijk Peter, van der Schaaf Arjen, Steenbakkers Roel J H M, Sijtsema Nanna M, Hutcheson Katherine A, Fuller Clifton D, Langendijk Johannes A, Moreno Amy C, van Dijk Lisanne V
机构信息
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Department of Oncology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
出版信息
Oral Oncol. 2025 Apr;163:107224. doi: 10.1016/j.oraloncology.2025.107224. Epub 2025 Mar 1.
BACKGROUND/PURPOSE: Normal tissue complication probability (NTCP) models can be used to guide radiation therapy (RT) decisions by estimating side-effect risks pretreatment to minimize (late) side-effects. Recently, a comprehensive individual toxicity risk (CITOR) profile of NTCP models addressing common side-effects in head and neck cancer (HNC) patients was developed. This study investigates the generalizability of these models in an international setting, with different treatment approaches and side-effect assessments, promoting their integration into more widespread clinical practice.
MATERIALS/METHODS: From a prospective registry study, 407 HNC patients were included who were treated with definitive RT with or without systemic therapy between 2015 and 2022. NTCP models predicting dysphagia, aspiration, xerostomia, sticky saliva, taste loss, speech problems, oral pain, and fatigue at 6 and 12 months after RT were evaluated. All side-effects were patient-rated using the MDASI-HN, except dysphagia which was reported by clinicians using the PSS-HN diet normalcy score. Model performance was appraised by discrimination (area under the curve [AUC]) and calibration.
RESULTS
CITOR models showed moderate-to-high performance in this cohort (mean AUC = 0.67[range = 0.55-0.80], moderate-to-good calibration). NTCP models for dysphagia, xerostomia, sticky saliva, and fatigue were the top performing models. Models for aspiration, taste loss and speech problems performed moderately well, which was partly explained by lower incidences.
CONCLUSION
Despite differences between the CITOR development and this evaluation cohort, including use of different side-effect scoring systems, most models exhibited moderate-to-high performance. This demonstrated that the dose-effect relations were generalizable. Therefore, this study supports further integration of these NTCP models in clinical practice.
背景/目的：正常组织并发症概率（NTCP）模型可通过在治疗前估计副作用风险来指导放射治疗（RT）决策，以尽量减少（晚期）副作用。最近，针对头颈癌（HNC）患者常见副作用开发了NTCP模型的综合个体毒性风险（CITOR）概况。本研究调查了这些模型在国际环境中的可推广性，涉及不同的治疗方法和副作用评估，以促进其融入更广泛的临床实践。
材料/方法：从一项前瞻性注册研究中，纳入了2015年至2022年间接受确定性放疗（无论是否联合全身治疗）的407例HNC患者。评估了预测放疗后6个月和12个月吞咽困难、误吸、口干、唾液黏稠、味觉丧失、言语问题、口腔疼痛和疲劳的NTCP模型。除吞咽困难由临床医生使用PSS-HN饮食正常评分报告外，所有副作用均由患者使用MDASI-HN进行评分。通过辨别力（曲线下面积[AUC]）和校准来评估模型性能。
结果
CITOR模型在该队列中表现出中到高的性能（平均AUC = 0.67[范围 = 0.55 - 0.80]，校准良好到中等）。吞咽困难、口干、唾液黏稠和疲劳的NTCP模型是表现最佳的模型。误吸、味觉丧失和言语问题的模型表现中等，部分原因是发病率较低。
结论
尽管CITOR开发队列与本评估队列之间存在差异，包括使用不同的副作用评分系统，但大多数模型表现出中到高的性能。这表明剂量-效应关系具有可推广性。因此，本研究支持将这些NTCP模型进一步整合到临床实践中。
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