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2026年8月20日星期四
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非小细胞肺癌根治性放疗中下叶剂量参数与放射性肺炎的相关性研究

Correlation Between Lower Lobe Dose Parameters and Radiation Pneumonitis in Definitive Radiation Therapy for Non-Small Cell Lung Cancer.

期刊
Thoracic Cancer
PMID
42615272
原文
PubMed ↗
发布日期

作者

  • Sachiko Miura — Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Nobuhide Wakai — Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Shigeto Hontsu — Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan.
  • Masahide Ota — Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan.
  • Kaori Yamaki — Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Tetsuro Tamamoto — Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Masayuki Takeda — Department of Cancer Genomics and Medical Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Fumiaki Isohashi — Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.

作者单位

  • Department of Radiation Oncology, Nara Medical University, Kashihara, Nara, Japan.
  • Department of Respiratory Medicine, Nara Medical University, Kashihara, Nara, Japan.
  • Department of Cancer Genomics and Medical Oncology, Nara Medical University, Kashihara, Nara, Japan.

摘要

中文

本研究探讨了在非小细胞肺癌（NSCLC）接受根治性放疗的患者中，分叶特异性剂量-体积直方图（DVH）参数能否在常规全肺参数之外增加放射性肺炎（RP）的预测信息。我们回顾性分析了2018年至2023年间接受治疗的145例NSCLC患者。分析了常规全肺参数，包括V5%、V20%和平均肺剂量（MLD），分叶特异性参数，包括Low V20%（双侧下叶接受≥20 Gy的百分比），以及临床参数。采用受试者工作特征曲线分析评估各参数对≥2级RP的预测性能。通过Gray检验和Fine-Gray竞争风险回归评估与≥2级RP的关联。≥2级RP的发生率为41%（60/145），与V20%（p=0.005）、MLD（p=0.025）、Low V5%（p=0.006）和Low V20%（p=0.003）显著相关。多变量分析中，高Brinkman指数（BI）（HR=2.10, 95%CI: 1.27-3.48, p=0.004）和高Low V20%（HR=2.31, 95%CI: 1.12-4.74, p=0.023）是≥2级RP的独立预测因子。V20%与Low V20%之间的相关性中等（r=0.505），多重共线性极小（方差膨胀因子1.34）。Low V20%与≥2级RP独立相关，可能为常规全肺DVH参数和BI提供补充信息。这一简单的分叶特异性参数可能有助于优化治疗前RP风险分层，但在纳入个体化计划约束之前仍需外部验证。

English

This study examined whether lobar-specific dose-volume histogram (DVH) parameters add predictive information for radiation pneumonitis (RP) beyond conventional whole-lung parameters in patients with non-small cell lung cancer (NSCLC) undergoing definitive radiotherapy. We retrospectively analyzed 145 NSCLC patients treated between 2018 and 2023. Conventional whole-lung parameters, including V5%, V20%, and mean lung dose (MLD), lobar-specific parameters, including Low V20% (percentage of the bilateral lower lobes receiving ≥ 20 Gy), and clinical parameters were analyzed. The predictive performance of each parameter for Grade ≥ 2 RP was evaluated using receiver operating characteristic curve analysis. Associations with Grade ≥ 2 RP were assessed by Gray test and Fine-Gray competing risks regression. Grade ≥ 2 RP had an incidence of 41% (60/145) and showed significant associations with V20% (p = 0.005), MLD (p = 0.025), Low V5% (p = 0.006), and Low V20% (p = 0.003). In multivariate analysis, a high Brinkman Index (BI) (HR = 2.10, 95% CI: 1.27-3.48, p = 0.004) and high Low V20% (HR = 2.31, 95% CI: 1.12-4.74, p = 0.023) were independent predictors for Grade ≥ 2 RP. The correlation between V20% and Low V20% was moderate (r = 0.505), with minimal multicollinearity (variance inflation factor 1.34). Low V20% was independently associated with Grade ≥ 2 RP and may provide complementary information to conventional whole-lung DVH parameters and BI. This simple lobar-specific parameter may help refine pretreatment RP risk stratification, although external validation is required before its incorporation into individualized planning constraints.

分类与指标

研究类型
临床研究
病种
肺癌
JCR 分区
Q2
影响因子
2.6
新锐分区
4区