文章摘要

构建食管癌放射治疗致放射性皮炎的预测模型

作者: 1惠琳, 1王静
1 江南大学附属医院肿瘤放疗科,江苏 无锡 214000
通讯: 惠琳 Email: czzhuangchen45@163.com
DOI: 10.3978/j.issn.2095-6959.2022.12.012

摘要

目的:依据logistic回归分析构建食管癌放射治疗致放射性皮炎的预测模型并检验其准确性。方法:随机选取2017年1月至2022年3月在江南大学附属医院肿瘤放疗科接受食管癌放射治疗的152例患者,随机分为建模组(n=90)与验证组(n=62)。建模组根据是否发生放射性皮炎分为皮炎组与无皮炎组,采用单因素和多因素logistic回归分析筛选临床危险因素。根据危险因素权重构建预测评分模型,将放射性皮炎发生风险分为低危、中危和高危3个等级,采用受试者工作特征(receiver operating characteristic,ROC)曲线分析建模组与验证组的准确性。结果:建模组放射性皮炎0级21例(23.33%),1级54例(60.00%),2级11例(12.22%),3级4例(4.44%)。Logistics回归分析结果显示:肿瘤直径、手术并发症、照射剂量、血清白蛋白水平、合并糖尿病、体重指数(body mass index,BMI)、使用补偿膜(Bolus)均是放射性皮炎发生的重要危险因素(均P<0.05);建模组低危、中危和高危放射性皮炎分别有3、13、53例,验证组分别有1、11、35例,ROC曲线下面积(area under the curve,AUC)分别为0.968和0.953。Hosmer-Lemeshow检验拟合优度均较好(分别χ2=87.148,P=0.059;χ2=72.433,P=0.058)。结论:食管癌放射治疗致放射性皮炎发生的主要临床危险因素有肿瘤直径、手术并发症、照射剂量、血清白蛋白水平、合并糖尿病、BMI及是否使用Bolus,所构建预测模型能定量评估发生风险,与实际吻合度较高,具有较高的临床推广应用价值。
关键词: logistic回归分析;食管癌;放射治疗;放射性皮炎;预测模型

Construction of a predictive model for radiation dermatitis induced by radiotherapy for esophageal cancer

Authors: 1HUI Lin, 1WANG Jing
1 Department of Radiation Oncology, Affiliated Hospital of Jiangnan University, Wuxi Jiangsu 214000, China

CorrespondingAuthor: HUI Lin Email: czzhuangchen45@163.com

DOI: 10.3978/j.issn.2095-6959.2022.12.012

Abstract

Objective: To construct a predictive model for radiation dermatitis induced by radiation therapy for esophageal cancer based on logistic regression analysis and to test its accuracy. Methods: A total of 152 patients receiving radiotherapy for esophageal cancer in Department of Radiation Oncology of Affiliated Hospital of Jiangnan University from January 2017 to March 2022 were selected and randomly divided into a modeling group (n=90), including dermatitis and no dermatitis, and a validation group (n=62). Univariate and multivariate logistic regression analysis were used to screen clinical factors. The predictive score model was constructed according to the risk factor weight, the risk of radiation dermatitis was divided into three grades: low risk, medium risk, and high risk. The risk factor weights of different risk levels in the modeling group and the validation group were recorded. The receiver operating characteristic (ROC) curve was used to analyze the accuracy of the modeling group and validation group. Results: In the modeling group, grade 0 radiation dermatitis occurred in 21 patients (23.33%), grade 1 in 54 patients (60.00%), grade 2 in 11 patients (12.22%), and grade 3 in 4 patients (4.44%). Logistic regression analysis showed that tumor diameter, surgical complications, radiation dose, serum albumin level, combined diabetes, body mass index (BMI), and the use of compensation membrane (Bolus) were the important risk factors for radiation dermatitis (all P<0.05). The number of low-risk, medium-risk and high-risk radiation dermatitis cases in the modeling group were 3, 13, and 53, respectively, and that in the validation group were 1, 11, and 35, respectively. The area under the curve (AUC) of ROC was 0.968 and 0.953 respectively. Hosmer-Lemeshow test showed good goodness of fit (χ2=87.148, P=0.059; χ2=72.433, P=0.058, respectively). Conclusion: The main clinical risk factors for radiation dermatitis induced by radiotherapy for esophageal cancer are tumor diameter, surgical complications, radiation dose, serum albumin level, comorbidity with diabetes, BMI, and the use of Bolus. The constructed prediction model can quantitatively assess the risk. It has a high degree of agreement with the actual situation and has high clinical application value.

Keywords: logistic regression analysis; esophageal cancer; radiation therapy; radiodermatitis; prediction model

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