鼻咽癌放疗患者显著体重丢失的列线图模型构建及验证

doi:10.3760/cma.j.issn.1007-1245.2024.19.013

摘要/Abstract

摘要：

目的　本研究旨在用列线图构建鼻咽癌调强放射治疗（IMRT）患者显著体重丢失的预测模型并验证。方法　前瞻性研究，纳入2018年1月至2023年6月在商洛市中心医院接受鼻咽癌IMRT患者74例作为研究对象，以放疗期间体重丢失≥10%为显著体重丢失标准，将患者分为显著体重丢失组（CWL组）34例和未显著体重丢失组（non-CWL组）40例。CWL组男25例、女9例，年龄（48.29±8.47）岁；non-CWL组男28例、女12例，年龄（45.79±7.69）岁。单因素分析两组年龄、体质量指数、吸烟史、病理类型、肿瘤家族史等资料，通过多因素logistic回归分析鼻咽癌IMRT患者显著体重丢失的危险因素，根据结果建立列线图预测模型，并采用校准曲线进行验证。统计学方法采用t检验、χ²检验。结果　两组患者国际抗癌联盟（UICC）N分期比较，差异有统计学意义（χ²=12.730，P<0.05）；CWL组放疗期间使用化疗药物、EB病毒拷贝数>1 500 copies/ml、颈部放疗剂量均高于non-CWL组［97.74%（33/34）比75.00%（30/40）、52.63%（23/34）比 37.50%（15/40）、（70.61±2.79）Gy比（65.75±2.53）Gy］，放疗后白蛋白、血红蛋白和前白蛋白水平均低于non-CWL组［（37.48±3.91）g/L比（40.24±4.79）g/L、（109.79±16.97）g/L比（120.97±17.82）g/L、（206.58±37.16）mg/L比（229.75±34.39）mg/L］，差异均有统计学意义（χ²=7.066、6.686，t=7.855、2.684、2.749、2.783；均P<0.05）。多因素logistic 回归分析结果显示，高N分期、颈部放疗剂量高、放疗期间使用化疗药、高EB病毒拷贝数、放疗后低白蛋白、血红蛋白和前白蛋白水平是鼻咽癌患者放疗期间显著体重丢失的独立危险因素（均P<0.05）。据此建立的列线图预测模型能有效预测鼻咽癌IMRT患者显著体重丢失的发生，校准曲线验证表明模型具有良好的预测准确性。结论　高N分期、颈部放疗剂量高、放疗期间使用化疗药物、高EB病毒拷贝数、放疗后低白蛋白水平、血红蛋白水平和前白蛋白水平是鼻咽癌患者显著体重丢失的高风险因素，在治疗中应加以重视并采取相应预防措施。

关键词:

鼻咽癌, 体重丢失, 调强放射治疗, 列线图, logistic回归分析

Abstract:

Objective To construct and validate a nomogram model for predicting significant weight loss in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiation therapy (IMRT). Methods　This prospective study included 74 patients with nasopharyngeal carcinoma (NPC) who received IMRT at Shangluo Central Hospital from January 2018 to June 2023. Significant weight loss was defined as a weight loss ≥10% during radiotherapy. The patients were divided into a CWL group (34 cases) and a non-CWL group (40 cases). There were 25 males and 9 females in the CWL group; they were (48.29±8.47) years old. There were 28 males and 12 females in the non-CWL group; they were (45.79±7.69) years old. Univariate analysis was conducted on ages, body mass indexes (BMI), smoking history, pathological types, family history of tumors, and other data in both groups. Multivariate logistic regression analysis was used to identify the risk factors for significant weight loss in the patients; a nomogram prediction model was established based on the results. Calibration curves were used for the validation. t and χ² tests were employed for the statistical analysis. Results　There was a statistical difference in N staging of Union for International Cancer Control (UICC) between the two groups (χ²=12.730, P<0.05). The proportions of the patients using chemotherapy drugs during radiotherapy and whose Epstein-Barr virus (EBV) copy number >1 500 copies/ml, neck radiotherapy dosage in the CWL group were higher than those in the non-CWL group [97.74% (33/34) vs. 75.00% (30/40), 52.63% (23/34) vs. 37.50% (15/40), (70.61±2.79) Gy vs. (65.75±2.53) Gy]; the levels of albumin hemoglobin, and prealbumin after the radiotherapy in the CWL group were lower than those in the non-CWL group [(37.48±3.91) g/L vs. (40.24±4.79) g/L, (109.79±16.97) g/L vs. (120.97±17.82)g/L, and (206.58±37.16) mg/L vs. (229.75±34.39) mg/L]; there were statistical differences (χ²=7.066 and 6.686; t=7.855, 2.684, 2.749, and 2.783; all P<0.05). The multivariate logistic regression analysis revealed that high N staging, high neck radiation dosage, use of chemotherapy during radiotherapy, high EB virus copy number, and low levels of albumin, hemoglobin, and prealbumin after radiotherapy were independent risk factors for significant weight loss in the patients (all P<0.05). The nomogram model constructed could effectively predict the occurrence of significant weight loss in the patients, and the calibration curve validation indicated a good predictive accuracy of the model. Conclusion　Patients with high N staging, high neck radiation dosage, use of chemotherapy during radiotherapy, a high EB virus copy number, and low levels of albumin, hemoglobin, and prealbumin after radiotherapy have high risk of significant weight loss and should be given special attention and corresponding preventive measures during treatment.

Key words:

Nasopharyngeal carcinoma, Weight loss, Intensity-modulated radiation therapy, Nomogram, Logistic regression analysis

车亚任英红郭峰陈根祥赵本华.

鼻咽癌放疗患者显著体重丢失的列线图模型构建及验证 [J]. 国际医药卫生导报, 2024, 30(19): 3229-3235.

Che Ya, Ren Yinghong, Guo Feng, Chen Genxiang, Zhao Benhua.

Construction and validation of a nomogram model for predicting significant weight loss in patients with nasopharyngeal carcinoma undergoing radiotherapy [J]. International Medicine and Health Guidance News, 2024, 30(19): 3229-3235.

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