摘要
目的 探讨鼻咽癌放疗患者临床因素及口腔剂量体积参数与重度(≥3级)放射性口腔黏膜炎(ROM)发生的关系,分析发生重度ROM的预测因素,为预防重度ROM的发生提供理论依据。方法 回顾性收集本院头颈肿瘤科2020-01-01-2021-12-31收治的173例鼻咽癌患者临床资料,单因素和多因素logistic回归分析鼻咽癌患者临床因素和口腔剂量体积参数与重度ROM的关系。结果 重度ROM的发生率为50.9%(88/173)。单因素分析结果显示,吸烟(χ^(2)=7.985,P=0.005)、原发肿瘤体积≥55.28 cm^(3)(χ^(2)=8.787,P=0.003)、口腔剂量体积参数V_(20)(t=-5.307,P<0.001)、V_(30)(t=-5.549,P<0.001)、V_(40)(t=-2.824,P=0.005)、V_(50)(t=-2.444,P=0.016)、V_(60)(t=-2.440,P=0.016)、V_(70)(t=-3.389,P=0.001)、平均剂量D_(mean)(t=-2.911,P=0.004)和最大剂量D_(max)(t=-2.963,P=0.003)与重度ROM的发生有统计学关联。多因素logistic回归分析结果显示,吸烟(RR=2.802,95%CI:1.167~6.729,P=0.021)、原发肿瘤体积≥55.28 cm^(3)(RR=2.497,95%CI:1.305~4.777,P=0.006)和口腔黏膜受照体积V_(30)(RR=1.061,95%CI:1.010~1.115,P=0.018)是重度ROM发生的独立危险因素。受试者工作特征曲线分析明确口腔V_(30)的临界值为80.55%,曲线下面积为0.766(95%CI:0.695~0.838)。结论 吸烟、肿瘤体积大小和口腔V_(30)是鼻咽癌放疗期间发生重度ROM的独立危险因素,可作为重度ROM发生的预测指标。
Objective To investigate the correlation between clinical factors and oral dose-volume parameters and severe(≥grade 3) radiation-induced oral mucositis(ROM) in nasopharyngeal carcinoma patients undergoing radiotherapy,and to identify predictive factors for severe ROM,providing a reference for clinical radiotherapy planning evaluation.Methods The clinical data of 173 nasopharyngeal carcinoma patients treated with radiotherapy were retrospectively collected in Second Affiliated Hospital of Zunyi Medical University from 1 January 2020 to 31 December 2021.Univariate and multivariate logistic regression analyses were performed to evaluate the relationships between clinical factors,oral dose-volume parameters,and severe ROM.Results The incidence of severe ROM was 50.9%(88/173).The results of univariate analysis showed that smoking(χ^(2)=7.985,P=0.005),primary tumor volume ≥55.28 cm^(3)(χ^(2)=8.787,P=0.003),oral dose volume parameters V_(20)(t=-5.307,P<0.001),V_(30)(t=-5.549,P<0.001),V_(40)(t=-2.824,P=0.005),V_(50)(t=-2.444,P=0.016),V_(60)(t=-2.440,P=0.016),V_(70)(t=-3.389,P=0.001),the average dose D_(mean)(t=-2.911,P=0.004) and maximum dose D_(max)(t=-2.963,P=0.003) were statistically correlated with the occurrence of severe ROM.The results of multivariate logistic regression analysis showed that smoking(RR=2.802,95%CI:1.167-6.729,P=0.021),primary tumor ≥55.28 cm^(3)(RR=2.497,95%CI:1.305-4.777,P=0.006),and exposure volume of oral mucosa V_(30)(RR=1.061,95%CI:1.010-1.115,P=0.018) were independent risk factors for the occurrence of severe ROM.The analysis of the receiver operating characteristic curve of the subjects confirmed that the critical value of oral V_(30) was 80.55%,and the area under the curve was 0.766(95% CI:0.695-0.838).Conclusion Smoking,tumor volume,and oral cavity V_(30) are independent risk factors for the occurrence of severe ROM during radiotherapy in nasopharyngeal carcinoma patients and can serve as predictive indicators for it.
作者
陈念
柏玉举
胡作怀
付建东
王建文
毛雯婷
苟小霞
CHEN Nian;BAI Yuju;HU Zuohuai;FU Jiandong;WANG Jianwen;MAO Wenting;GOU Xiaoxia(Second Affiliated Hospital of Zunyi Medical University,Zunyi,Guizhou 563000,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2023年第21期1279-1285,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
贵州省卫生健康委科学技术基金(gzwkj2021-053)
贵州省抗癌协会科技计划[抗协科技006(2023)]
遵义医科大学第二附属医院硕士科研启动资金(SQ-2021-05)。
关键词
鼻咽癌
放射治疗
放射性口腔黏膜炎
临床因素
剂量体积参数
nasopharyngeal carcinoma
radiotherapy
radiation oral mucositis
clinical factors
dose-volume parameters
