Hurmuz Pervin, Ozyurek Yasin, Yigit Ecem, Yalcin Suayib, Yedekci Fazli Yagiz, Zorlu Faruk, Cengiz Mustafa
Department of Radiation Oncology, Hacettepe University, Faculty of Medicine, Ankara, Türkiye.
Department of Medical Oncology, Hacettepe University, Faculty of Medicine, Ankara, Türkiye.
Radiat Oncol J. 2025 Mar;43(1):30-39. doi: 10.3857/roj.2024.00409. Epub 2025 Feb 26.
This study aimed to investigate the risk factors and predictive value of vertebral Hounsfield units (HUs) for vertebral compression fracture (VCF) development in gastric cancer (GC) patients who received adjuvant radiotherapy (RT).
We retrospectively analyzed the data of 271 patients with non-metastatic GC who received adjuvant RT between 2010 and 2020. The vertebral bodies from 9th thoracic (T9) to 2nd lumbar (L2) were contoured in computed tomographies used for RT planning, and V30, V35, V40, mean doses, and HUs of vertebrae were documented. We conducted univariate and multivariate analyses to identify the risk factors for VCF development.
The median follow-up time was 35.7 months. VCF developed in 23 patients (8.5%) in a median of 30.6 months (range, 3.4 to 117.3) after the end of RT. In total, 37 vertebrae were fractured, with 14 located in T12, nine in L1, seven in T11, four in L2, and three in T10. Older age, female sex, non-smoking status, and lower median vertebrae HUs were significantly associated with VCF in the univariate analysis. In the multivariate analysis, lower median HUs of T12 vertebrae (odds ratio, 0.965; 95% confidence interval, 0.942 to 0.989; p = 0.004) remained significant. The optimal cut-off value for T12 HU was 205.1, with an area under the receiver operating characteristic curve of 0.765, sensitivity of 85.7%, and specificity of 65%.
The lower median HU value of T12 vertebrae is a significant and independent risk factor for VCF development in GC patients who received adjuvant RT. HUs values serve as a simple and reliable predictor of VCF development in this population.
本研究旨在调查接受辅助放疗（RT）的胃癌（GC）患者中椎体Hounsfield单位（HU）对椎体压缩性骨折（VCF）发生的危险因素及预测价值。
我们回顾性分析了2010年至2020年间接受辅助放疗的271例非转移性GC患者的数据。在用于放疗计划的计算机断层扫描中勾勒出第9胸椎（T9）至第2腰椎（L2）的椎体轮廓，并记录椎体的V30、V35、V40、平均剂量和HU。我们进行了单因素和多因素分析以确定VCF发生的危险因素。
中位随访时间为35.7个月。放疗结束后，23例患者（8.5%）发生VCF，中位时间为30.6个月（范围3.4至117.3个月）。总共37个椎体发生骨折，其中14个位于T12，9个位于L1，7个位于T11，4个位于L2，3个位于T10。在单因素分析中，年龄较大、女性、不吸烟状态以及较低的椎体中位HU与VCF显著相关。在多因素分析中，T12椎体较低的中位HU（比值比，0.965；95%置信区间，0.942至0.989；p = 0.004）仍然具有显著性。T12 HU的最佳截断值为205.1，受试者工作特征曲线下面积为0.765，敏感性为85.7%，特异性为65%。
T12椎体较低的中位HU值是接受辅助放疗的GC患者发生VCF的一个显著且独立的危险因素。HU值可作为该人群中VCF发生的简单可靠预测指标。
