临床肿瘤学杂志

目的 分析食管癌患者行调强适行放疗(IMRT)的疗效和发生急性放射性肺损伤(ARILI)的风险因素，并构建相关的回归模型。方法 收集2021年1月至2024年6月河南科技大学第一附属医院收治的312例行IMRT的食管癌患者的临床病历资料，根据其放疗后随访6个月是否发生ARILI分为发生组(53例，RTOG分级1～4级)和未发生组(259例，RTOG分级0级)。分析两组患者疗效、不良反应发生情况，采用单因素和多因素Logistic回归分析影响食管癌患者IMRT发生ARILI的因素，并构建模型。结果 312例患者IMRT结束后，完全缓解245例(78.53%)，部分缓解61例(19.55%)，无缓解6例(1.92%)，总缓解率为98.08%；发生放射性食管炎29例(9.29%)、ARILI53例(16.99%)、骨髓抑制31例(9.94%)、胃肠道反应15例(4.81%)。与未发生ARILI组比较，发生组放疗总剂量≥60 Gy、淋巴结转移的患者占比更高，肺V₅、肺V₁₀、肺V₂₀、肺V₃₀、全肺平均剂量(MLD)、血清白介素(IL)-8、转化生长因子-β1(TGF-β1)水平均更高(P<0.05)。多因素Logistic回归分析结果显示，肺V₅>50%、肺V₂₀>25%、肺V₃₀>20%、血清IL-8水平偏高、血清TGF-β1水平偏高均为食管癌患者IMRT后发生ARILI的危险因素(OR=1.608、2.523、2.087、1.020、1.014,P<0.05)。据此构建回归方程：Logit(P)=-109.606+肺V₅×0.475+肺V₂₀×0.925+肺V₃₀×0.736+血清IL-8水平×0.019+血清TGF-β1水平×0.014。受试者工作特征曲线(ROC)结果显示，当logit(P)>0.20时，曲线下面积(AUC)值为0.999,95%CI为0.997～1.000，敏感度为100.00%，特异度为98.84%。结论 食管癌患者行IMRT的效果良好，安全性一般，食管癌患者行IMRT发生ARILI的危险因素为肺V₅>50%、肺V₂₀>25%、肺V₃₀>20%、血清IL-8水平偏高、血清TGF-β1水平偏高，由此建立的模型对符合上述特点的患者可以采取有针对性的治疗和干预措施，帮助改善患者预后。

Objective To analyze the efflcacy of intensity-modulated radiotherapy(IMRT) in patients with esophageal cancer and the risk factors of acute radiation-induced lung injury(ARILI), and to construct the relevant regression model. Methods The clinical medical records of 312 esophageal cancer patients who underwent IMRT and were admitted to the first afflliated hospital of Henan university of science and technology from January 2021 to June 2024 were collected as the research objects. They were divided into the occurrence group(53 cases, RTOG grades 1-4) and the non-occurrence group(259 cases) based on whether ARILI occurred during the 6-month follow-up after radiotherapy. RTOG grade 0. The therapeutic effects and the occurrence of adverse reactions of the two groups of patients were analyzed. Univariate and multivariate Logistic regression analyses were used to analyze the factors influencing the occurrence of ARILI in patients with esophageal cancer undergoing IMRT, and a model was constructed. Results Among the 312 patients after IMRT, 245 cases(78.53%) achieved complete remission, 61 cases(19.55%) achieved partial remission, 6 cases(1.92%) had no remission, and the total remission rate was 98.08%. There were 29 cases(9.29%) of radiation esophagitis, 53 cases(16.99%) of ARILI, 31 cases(9.94%) of bone marrow suppression, and 15 cases(4.81%) of gastrointestinal reactions. Compared with the group without ARILI, the proportion of patients with a total radiotherapy dose of ≥60 Gy and lymph node metastasis was higher in the group with ARILI, and the levels of lung V₅, lung V₁₀, lung V₂₀, lung V₃₀, average lung dose(MLD), serum interleukin(IL)-8, and transforming growth factor-β1(TGF-β1) were all higher(P<0.05). The results of multivariate Logistic regression analysis showed that Lung V₅>50%, lung V₂₀>25%, lung V₃₀>20%, elevated serum IL-8 level, and elevated serum TGF-β1 level are all risk factors for ARILI in patients with esophageal cancer after IMRT(OR=1.608, 2.523, 2.087, 1.020, 1.014, P<0.05). Based on this, a regression equation was constructed: logit(P) =-109.606+ lung V₅×0.475+ lung V₂₀×0.925+ lung V₃₀×0.736+ serum IL-8 level ×0.019+ serum TGF-β1 level ×0.014. The results of the receiver operating characteristic curve(ROC) showed that when Logit(P) >0.20, the area under the curve(AUC) value was 0.999, the 95%CI was 0.997 to 1.000, the sensitivity was 100.00%, and the specificity was 98.84%. Conclusion The effect of IMRT in patients with esophageal cancer is good, but the safety is average. The risk factors for ARILI in patients with esophageal cancer undergoing IMRT are lung V₅>50%, lung V₂₀>25%, lung V₃₀>20%, high serum IL-8 level, and high serum TGF-β1 level. The model established in this way can take targeted treatment and intervention measures for patients who meet the above characteristics, helping to improve the prognosis of patients.