高压氧治疗乳腺癌急性放射性皮炎效果的影响因素分析及Nomogram预测模型的建立OA

Objective To explore the factors influencing the efficacy of hyperbaric oxygen therapy(HBOT)for acute radiodermatitis(AR)induced by image-guided radiotherapy(IGRT)following modified radical mastectomy for breast cancer,and to develop a Nomogram prediction model for therapeutic effect.Methods A total of 600 patients who received IGRT after modified radical mastectomy at the First Affiliated Hospital of Hebei North University from January 2022 to January 2025 were collected as research objects for retrospective analysis.Using a computer-generated random number table,the patients were randomly divided into a modeling group(n=360)and a validation group(n=240)at a ratio of 6:4.Univariate and multivariate logistic regression analyses were performed to identify the independent risk factors associated with a final treatment outcome of grade Ⅱ or above AR in the modeling group.The"RMS"package in R language was used to construct a prediction model based on these independent risk factors.The model was evaluated using the concordance index(C-index),calibration curve,and decision curve analysis.Internal validation was conducted using receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results Univariate analysis showed that in modeling group,the proportion of patients with age≥40 years,and those with hypertension,diabetes,immune deficiency,vascular disease,and a history of chemotherapy was significantly higher in the grade Ⅱ or above AR group than that in the lower grade AR group(P<0.05).Multivariate logistic regression analysis identified advanced age(OR=3.216,95%CI 1.198-8.295),hypertension(OR=3.397,95%CI 1.112-11.231),diabetes(OR=3.854,95%CI 1.396-10.734),immune deficiency(OR=5.094,95%CI 1.098-22.784),vascular disease(OR=5.743,95%CI 2.084-15.804),and a history of chemotherapy(OR=7.553,95%CI 2.804-20.622)as the independent risk factors for grade Ⅱ or above AR(P<0.05).Model evaluation yielded a C-index of 0.845(95%CI 0.801-0.877),indicating good concordance and a positive clinical net benefit.Internal validation showed no statistically significant difference in the ROC curves and AUC values for predicting grade Ⅱ or above AR between the modeling and validation groups(0.838 vs.0.827,P=0.487).Conclusions Caution is advised when considering HBOT for patients with advanced age,hypertension,diabetes,immune deficiency,vascular disease,and a history of chemotherapy;HBOT should be postponed until these conditions are well-controlled.The prediction model developed in the study can be used to rapidly identify patients who may not be suitable for HBOT.