子宫内膜癌相关放射性直肠损伤的多因素分析与风险预测模型构建

Multivariate analysis and risk prediction model construction of radiation-induced rectal injury in patients with endometrial cancer undergoing pelvic radiotherapy

中文关键词: 老年  子宫内膜癌  盆腔放疗  放射性直肠损伤  危险因素

英文关键词: elderly  endometrial cancer  pelvic radiotherapy  radiation-induced rectal injury  risk factor

中文摘要:

      目的 分析子宫内膜癌放疗致放射性直肠损伤(RRI)的影响因素,并进行风险预测模型构建及验证.方法 选取2020年2月—2023年2月于南通大学附属肿瘤医院收治的子宫内膜癌行盆腔放疗的老年患者86例,根据RTOG/EORTC分级,将0～1级患者划归为＜2级RRI组(n=36),而2～4级患者划归为≥2级RRI组(n=50).采用单因素、Logistic多因素回归分析法对≥2级RRI发生的高危因素进行分析.结果 Logistic回归分析显示,年龄＞75岁、肿瘤直径≥4 cm、临床分期Ⅲ～Ⅳ期、HAD评分高(11～21分)、SSRS评分低(分值＜20分)、直肠平均受照剂量(mean)≥40 Gy、浸润程度≥1/2及放疗时间≥4周均为导致子宫内膜癌放疗患者发生≥2级RRI的独立危险因素(P＜0.05).构建子宫内膜癌放疗后≥2级RRI的风险预测模型,其Hosmer-Lemeshow检验(x2=5.138,P＞0.05),预测模型的AUC为0.912,95％CI为0.856～0.962,表明子宫内膜癌放疗致≥2级RRI的预测模型有较好的拟合度和预测效能(P＜0.05).结论 子宫内膜癌放疗易发生≥2级RRI,这可能与患者的年龄、肿瘤直径、临床分期、HAD评分、SSRS评分、直肠mean≥40 Gy、浸润程度及放疗时间等因素相关,根据各危险因素构建模型可以较好地预测子宫内膜癌放疗后≥2级RRI概率.

英文摘要:

      Objective To analyze the influencing factors of radiation-induced rectal injury(RRI)in endometrial cancer radiotherapy,and construct and validate a risk prediction model.Methods 86 patients with endometrial cancer who underwent pelvic radiotherapy in Oncology Hospital Affiliated to Nantong University from February 2020 to February 2023 were selected.According to the RTOG/EORTC grading,patients with grades 0 to 1 were classified as＜grade 2 RRI group(n=36),while patients with grade 2 to 4 were classified as ≥ grade 2 RRI group(n=50).Univariate and Logistic multivariate regression anal-ysis were used to analyze the high-risk factors for the occurrence of ≥ grade 2 RRI.Results Logistic regression analysis showed that age＞75 years,tumor diameter≥4 cm,clinical stages Ⅲ-Ⅳ,high HAD score(11-21 points)and low SSRS score(＜20 points),mean rectal radiation dose(mean)≥40 Gy,infiltration degree ≥1/2,and radiotherapy time ≥4 weeks were all independent risk factors for ≥ grade 2 RRI in patients with endometrial cancer undergoing radiotherapy(P＜0.05).A risk pre-diction model of ≥ grade 2 RRI after radiotherapy for endometrial cancer was constructed.The Hosmer Lemeshow test(x2=5.138,P＞0.05)showed that the AUC of the predictive model was 0.912,and the 95％CI was 0.856-0.962.It indicated that the model has good fitting and predictive performance in predicting ≥ grade 2 RRI induced by radiotherapy for endometrial canc-er(P＜0.05).Conclusion Endometrial cancer radiotherapy is prone to≥ grade 2 RRI,which may be related to many factors such as patient age,tumor diameter,clinical stage,HAD score,SSRS score,rectal mean ≥40 Gy,degree of infiltration,and radiotherapy time.The model constructed based on various risk factors can effectively predict the probability of ≥ grade 2 RRI after radiotherapy for endometrial cancer.