基于腮腺干细胞区剂量学参数的预测模型评估鼻咽癌根治性放疗后长期存活患者放射性口干的恢复情况。

IF 5.3 1区医学 Q1 ONCOLOGY

Radiotherapy and Oncology Pub Date : 2025-09-26 DOI:10.1016/j.radonc.2025.111163

Mai Zhang , Jie Gong , Yong Zhu , Zhi-Hua Yang , Yong-Chun Zhou , Jing Hu , Hui Guo , Hai-Liang Li , Quan Shi , Zhong-Fei Wang , Chang-Hao Liu , Ning Su , Li-Na Zhao , Mei Shi , Jian Zang

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引用次数: 0

摘要

背景：对于双侧腮腺近高剂量区鼻咽癌（NPC）患者，腮腺干细胞区（SCR）辐射对口干的影响尚需进一步研究。这项多中心研究旨在探讨SCR辐射剂量学参数和影响长期幸存者辐射性口干恢复的临床因素。方法：我们分析了来自中国四个中心的648例接受根治性放疗的鼻咽癌患者。通过患者报告（PRO）和医生评估（PAO）结果评估恢复情况。Cox比例风险模型确定了影响康复的关键临床和剂量学因素，旨在建立一个综合预测模型。预后表现以受试者工作特征曲线下的时间依赖面积（AUC）评估，累积发生率曲线估计不同风险组的恢复情况。结果：患者在7:3随机分配到训练组和验证组。多因素COX分析发现，年龄、诱导化疗、SCR Dmean和SCR V20是口干恢复的关键预测因素。使用这些因素的nomogram模型在预测PRO的口干恢复方面优于个体模型，3年/5年AUC分别为0.77/0.806（训练）和0.773/0.81（验证）；PAO恢复为0.756/0.786（训练）和0.748/0.786（验证）。根据模型得出的中位数得分，将整个队列分为高危组和低危组。值得注意的是，低风险组在训练集和验证集的恢复率均显著高于对照组（p ）。结论：SCR剂量学与临床因素相结合的模型可有效预测口干症的恢复。

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A predictive model based on the dosimetric parameters of the parotid stem cell region to assess the recovery of radiation-induced xerostomia in long-term survivors of nasopharyngeal carcinoma after radical radiotherapy

Background

For nasopharyngeal carcinoma (NPC) patients with bilateral parotids near high − dose areas, more research is needed on how radiation to the parotid stem cell region (SCR) impacts xerostomia. This multicenter study aims to explore SCR radiation dosimetric parameters and clinical factors that influence recovery from radiation-induced xerostomia in long-term survivors.

Methods

We analyzed 648 NPC patients from four Chinese centers who underwent radical radiotherapy. Recovery was assessed via patient-reported (PRO) and physician-assessed (PAO) outcomes. The Cox proportional hazards model identified key clinical and dosimetric factors for recovery, aiming to develop an integrated prediction model. Prognostic performance was evaluated with time-dependent area under the receiver operating characteristic curve (AUC), and Cumulative incidence curve estimated recovery across different risk groups.

Results

Patients were randomly allocated to training and validation sets at 7:3. Multivariate COX analysis identified age (p=0.000), induction chemotherapy (p=0.003), SCR Dmean (p=0.047), and SCR V20 (p=0.000) as key predictors for xerostomia recovery. A nomogram model using these factors outperformed individual ones in predicting xerostomia recovery for PRO recovery, 3-year/5-year AUC was 0.77/0.806 (training) and 0.773/0.81 (validation); for PAO recovery, it was 0.756/0.786 (training) and 0.748/0.786 (validation). Based on the median score derived from the model, the entire cohort was stratified into high-risk and low-risk groups. Notably, the low-risk group demonstrated a significantly higher recovery rate in both the training set and validation set (p < 0.001).

Conclusion

A model combining SCR dosimetry and clinical factors effectively predicts xerostomia recovery.

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来源期刊

Radiotherapy and Oncology 医学-核医学

CiteScore

10.30

自引率

10.50%

发文量

2445

审稿时长

45 days

期刊介绍： Radiotherapy and Oncology publishes papers describing original research as well as review articles. It covers areas of interest relating to radiation oncology. This includes: clinical radiotherapy, combined modality treatment, translational studies, epidemiological outcomes, imaging, dosimetry, and radiation therapy planning, experimental work in radiobiology, chemobiology, hyperthermia and tumour biology, as well as data science in radiation oncology and physics aspects relevant to oncology.Papers on more general aspects of interest to the radiation oncologist including chemotherapy, surgery and immunology are also published.