[Dosimetric factor analysis of the incidence of post-radiotherapy pneumonia after partial resection of laryngeal cancer and construction of a risk prediction nomogram model].

Q3 Medicine
R Huang, X X Lu, X M Sun, J Q He, H Wu
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引用次数: 0

Abstract

Objective: To explore the influencing factors for pneumonia occurrence within three months in patients undergoing partial laryngectomy combined with radiotherapy, and to construct a nomogram prediction model for the risk of pneumonia occurrence. Methods: A total of 165 patients with laryngeal squamous cell carcinoma who underwent partial laryngectomy combined with postoperative radiotherapy in the Affiliated Cancer Hospital of Zhengzhou University from 2017 to 2023 were divided into three groups: a group without pneumonia, a low risk pneumonia group, and a medium to high risk pneumonia group according to the occurrence of pneumonia. The receiver operating characteristic (ROC) curve was used to determine the optimal cutoff values of the mean dose to the larynx (Larynx-Dmean) and the mean dose to the pharyngeal constrictor muscles (PCM-Dmean) for predicting the occurrence of pneumonia. Logistic regression analysis was used to screen out the influencing factors of pneumonia within three months after partial laryngectomy combined with radiotherapy, and a nomogram prediction model was constructed. Results: Among the 165 patients, 59 were in the group without pneumonia, 60 were in the group with a low risk of pneumonia, and 46 were in the group with a medium to high risk of pneumonia. The overall incidence of pneumonia was 64.2% (106/165). ROC curve analysis showed that the area under the curve (AUC) of the Larynx-Dmean for predicting the occurrence of pneumonia was 0.876, and the optimal cutoff value was 60.8 Gy. When the Larynx-Dmean was >60.8 Gy, the incidence of pneumonia was 96.7%. The AUC of the PCM-Dmean for predicting the occurrence of pneumonia was 0.747, and the optimal cutoff value was 54.6 Gy. When the PCM-Dmean was >54.6 Gy, the incidence of pneumonia was 74.7%. The AUC of the Larynx-Dmean for predicting the occurrence of medium to high risk pneumonia was 0.987, and the optimal cutoff value was 68.2 Gy. When the Larynx-Dmean was >68.2 Gy, the incidence of medium to high risk pneumonia was 100.0%. The AUC of the PCM-Dmean for predicting the occurrence of medium to high risk pneumonia was 0.850, and the optimal cutoff value was 58.7 Gy. When the PCM-Dmean was >58.7 Gy, the incidence of medium to high risk pneumonia was 85.2%. Multivariate logistic regression analysis showed that the incidence of pneumonia was higher in patients with a history of smoking (OR=1.54, 95% CI: 1.02-1.74), a higher smoking index (OR=2.43, 95% CI: 1.16-7.59), a higher Larynx-Dmean (OR=3.79, 95% CI: 1.25-6.49), and a higher PCM-Dmean (OR=2.44, 95% CI: 1.53-3.16). A nomogram prediction model for the risk of pneumonia and medium to high risk pneumonia within three months after partial laryngectomy combined with radiotherapy was successfully constructed, with C indices of 0.78 and 0.98, respectively, which had good predictive performance and clinical efficacy. Conclusions: When the Larynx-Dmean was >60.8 Gy and the PCM-Dmean was >54.6 Gy for postoperative radiotherapy after partial laryngectomy, the possibility of pneumonia occurrence in patients within three months increased significantly. Smoking history, smoking index, Larynx-Dmean, and PCM-Dmean were independent influencing factors for the occurrence of pneumonia. The nomogram prediction model constructed based on this can guide clinicians to take intervention measures to prevent the occurrence of pneumonia in patients with laryngeal cancer.

[喉癌部分切除术后放疗后肺炎发病率的剂量学因素分析及风险预测nomogram模型的构建]。
目的:探讨喉部分切除术合并放疗患者3个月内肺炎发生的影响因素,构建肺炎发生风险的nomogram预测模型。方法:选取2017 - 2023年郑州大学附属肿瘤医院行喉部分切除术联合术后放疗的喉鳞癌患者165例,根据肺炎的发生情况分为无肺炎组、低危肺炎组和中高危肺炎组。采用受试者工作特征(ROC)曲线确定喉部平均剂量(喉- dmean)和咽收缩肌平均剂量(PCM-Dmean)预测肺炎发生的最佳截止值。采用Logistic回归分析筛选喉部分切除联合放疗后3个月内肺炎的影响因素,并构建nomogram预测模型。结果:165例患者中,无肺炎组59例,肺炎低危组60例,肺炎中高危组46例。肺炎总发病率为64.2%(106/165)。ROC曲线分析显示,喉均值预测肺炎发生的曲线下面积(AUC)为0.876,最佳截断值为60.8 Gy。当喉喉平均值为60.8 Gy时,肺炎的发生率为96.7%。PCM-Dmean预测肺炎发生的AUC为0.747,最佳临界值为54.6 Gy。PCM-Dmean为54.6 Gy时,肺炎的发生率为74.7%。预测中高危肺炎发生的喉均值AUC为0.987,最佳临界值为68.2 Gy。喉均值为68.2 Gy时,中高危肺炎的发生率为100.0%。PCM-Dmean预测中高危肺炎发生的AUC为0.850,最佳临界值为58.7 Gy。PCM-Dmean为58.7 Gy时,中高危肺炎的发生率为85.2%。多因素logistic回归分析显示,有吸烟史的患者肺炎发病率较高(OR=1.54, 95% CI: 1.02-1.74),吸烟指数较高(OR=2.43, 95% CI: 1.16-7.59),喉均值较高(OR=3.79, 95% CI: 1.25-6.49), PCM-Dmean较高(OR=2.44, 95% CI: 1.53-3.16)。成功构建了喉部分切除联合放疗后3个月内肺炎和中高危肺炎风险的nomogram预测模型,C指数分别为0.78和0.98,具有较好的预测性能和临床疗效。结论:喉部分切除术术后放疗,当喉- dmean为>60.8 Gy, PCM-Dmean为>54.6 Gy时,患者3个月内发生肺炎的可能性明显增加。吸烟史、吸烟指数、喉均值、pcm -均值是肺炎发生的独立影响因素。在此基础上构建的nomogram预测模型可以指导临床医生采取干预措施,预防喉癌患者肺炎的发生。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
中华肿瘤杂志
中华肿瘤杂志 Medicine-Medicine (all)
CiteScore
1.40
自引率
0.00%
发文量
10433
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