肺癌放疗后肺动脉照射与肺动脉高压的关联
Association of pulmonary artery radiation with pulmonary hypertension after lung cancer radiotherapy.
作者
作者单位
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA katelyn.atkins@cshs.org.
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA.
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, California, USA.
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Department of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital/Harvard Medical School, Boston, Massachusetts, USA.
摘要
中文
胸部放疗（RT）导致肺纤维化，推测可增加肺动脉高压（PH）的风险；然而，预测PH的心肺结构剂量效应尚未被系统研究。对接受胸部放疗的非小细胞肺癌患者进行多机构回顾性队列分析。对肺动脉（PA）、远端肺血管、肺和心脏进行分割。提取放疗剂量参数（平均、最大和以5 Gy增量接受X Gy的体积（V））。进行估计PH的受试者工作特征曲线下面积（AUROC）分析和Fine-Gray回归。在纳入的848例患者中（n=746发现队列；n=102验证队列），49.9%为女性，中位年龄为65岁（IQR，58-73岁）。PH的2年累积发生率为11.6%。PA V10 Gy在预测PH方面显示出最高的AUROC（0.58），且在调整心肺危险因素的多变量回归中与PH风险显著相关（发现队列：亚分布HR（sHR）1.01；95% CI 1.00至1.02；p=0.013；验证队列：sHR 1.03，95% CI 1.00至1.05；p=0.019）。在RT后发生PH的患者（与PH阴性相比）中，中度或重度三尖瓣疾病和右心室收缩功能障碍（RVSD）更常见（分别为18.7% vs 0.2%（p<0.001）和3.3% vs 0.2%（p=0.003））。胸部RT后PH常见，且与PA照射剂量相关。PH患者更可能有三尖瓣疾病和RVSD。这些产生假设的发现表明，胸部RT后的PH可能通过与RT诱导的肺纤维化不同的病理生理过程发生。
English
Thoracic radiotherapy (RT) results in pulmonary fibrosis that has been hypothesised to increase the risk of pulmonary hypertension (PH); however, dose effects to cardiopulmonary structures predicting PH have not been systematically studied. Multi-institutional retrospective cohort analysis of patients with non-small cell lung cancer treated with thoracic RT. The pulmonary arteries (PA), distal pulmonary vasculature, lungs and heart were segmented. Radiotherapy dose parameters (mean, maximum and volume (V) receiving X Gy in 5 Gy increments) were extracted. Area under the receiver operating curve (AUROC) analyses estimating PH and Fine-Gray regressions were performed. Of 848 patients included (n=746 discovery; n=102 validation), 49.9% were women and the median age was 65 years (IQR, 58-73 years). The 2-year cumulative incidence of PH was 11.6%. PA V10 Gy demonstrated the highest AUROC for predicting PH (0.58) and was significantly associated with the risk of PH on multivariable regression adjusting for cardiopulmonary risk factors in the discovery (subdistribution HR (sHR) 1.01; 95% CI 1.00 to 1.02; p=0.013) and validation (sHR 1.03, 95% CI 1.00 to 1.05; p=0.019) cohorts. In those who developed PH after RT (vs PH-negative), moderate or greater tricuspid disease and right ventricular systolic dysfunction (RVSD) were more common (18.7% vs 0.2% (p<0.001) and 3.3% vs 0.2% (p=0.003), respectively). PH was common following thoracic RT and associated with PA radiation dose. Patients with PH were more likely to harbour tricuspid disease and RVSD. These hypothesis-generating findings are suggestive that PH following thoracic RT may occur through a pathophysiological process distinct from RT-induced pulmonary fibrosis.
分类与指标
- 研究类型
- 临床研究
- 病种
- 肺癌
- JCR 分区
- Q1
- 影响因子
- 9.1
- 新锐分区
- 1区