非小细胞肺癌患者放射治疗后发生症状性放射性肺炎的影响因素分析及预测模型构建OA

Objective To analyze the influencing factors for symptomatic radiation pneumonitis(SRP)in patients with non-small-cell lung cancer(NSCLC)after radiotherapy and to construct a predictive model.Methods A total of 364 NSCLC patients who underwent radiotherapy were retrospectively selected and divided into the SRP group(90 cases)and non-SRP group(274 cases)based on the occurrence of SRP within 6 months after radiotherapy.Clinical data of the two groups were collected and compared,including basic information such as gender,age,smoking history,alcohol histo-ry,comorbid diabetes,comorbid hypertension,pathological type,tumor location,TNM stage,performance status score,combined chemotherapy,combined immunotherapy,combined targeted therapy,radiotherapy mode,prognostic nutrition-al index(PNI),neutrophil-to-lymphocyte ratio(NLR),as well as radiotherapy-related data such as radiation dose,tumor target volume,lymph node target volume,planning target volume,left lung volume,right lung volume,total lung vol-ume,percentage of total lung volume receiving a specific dose[lung V5,V10,V20,V30,V40,V50,and V60],and mean lung dose(MLD).Multivariate unconditional Logistic regression analysis was used to identify independent influencing factors for SRP in NSCLC patients after radiotherapy,and a nomogram model was constructed.The predictive perfor-mance of the model was evaluated using the receiver operating characteristic(ROC)curve,C-index,calibration curve,and decision curve analysis.Results The SRP group had higher age,higher proportion of combined chemotherapy,high-er NLR,higher lung V5,V10,V20,V30,and higher MLD than the non-SRP group(all P<0.05),while the PNI was lower in the SRP group(P<0.05).Multivariate unconditional Logistic regression analysis showed that increased age,combined che-motherapy,increased lung V5,increased MLD,and elevated NLR were independent risk factors for SRP in NSCLC patients after radiotherapy,while elevated PNI was an independent protective factor(all P<0.05).The nomogram model construct-ed based on these factors had a C-index of 0.919(95%CI:0.916-0.923).The calibration curve closely aligned with the ideal curve,and the decision curve analysis showed a wide range of net benefits.The ROC curve demonstrated that the ar-ea under the curve(AUC)of the nomogram model for predicting SRP in NSCLC patients after radiotherapy was 0.919(95%CI:0.887-0.945),with the sensitivity and specificity of 0.8556 and 0.8504,respectively.Conclusions Age,combined chemotherapy,lung V5,MLD,NLR,and PNI are independent influencing factors for SRP in NSCLC patients after radiotherapy.The nomogram model constructed based on these factors can effectively predict the risk of SRP in NSCLC patients after radiotherapy,with high discriminative ability,consistency,and clinical applicability.