Early Warning Factors and ROC Curve of Acute Radiation-induced Lung Injury in Patients with Esophageal Cancer Treated by Intensity Modulated Radiotherapy

WANG Hui; ZHU Lingchun; LI Min

doi:10.15926/j.cnki.issn2096-7381.2025.04.005

Abstract：Objective To analyze the early warning factors of acute radiation-induced lung injury(ARILI)in patients with esophageal cancer treated with intensity-modulated radiotherapy(IMRT).Methods 404 esophageal cancer patients who received IMRT from January 2021 to March 2024 in Shangqiu First People's Hospital were included in the study.They were divided into modeling group and verification group according to the ratio of 1∶1.According to whether ARILI occurred three months after radiotherapy,they were divided into occurrence group(108 cases,RTOG grade 1-4,including 54 cases in modeling group and 54 cases in verification group)and non-occurrence group(296 cases,RTOG grade 0,148 cases in modeling group and 148 cases in verification group).Univariate analysis and multivariate Logistic regression analysis were used to analyze the early warning factors of ARILI in the patients.Multi-factor analysis indexes were incorporated into the regression equation,the curve of receiver operating characteristics(ROC)was drawn,and their predictive value was analyzed.Results Compared with the non-occurrence group,the proportion of patients with lymph node metastasis,basic lung diseases and abnormal lung function,and the levels of V5,V10,V20,V30,whole lung mean dose(MLD),serum TGF-β1 and IL-8 in the occurrence group were higher(P＜0.05).Multivariate Logistic analysis showed that lymph node metastasis,basic lung disease,higher V5,higher V10,higher V20,higher V30,higher MLD and higher level of serum IL-8 were the early warning factors of ARILI in patients with esophageal cancer treated by IMRT,and the differences were statistically significant(P＜0.05).According to the regression equation,the ROC curve for predicting ARILI in patients with esophageal cancer treated by IMRT was drawn,which results showed that when logit(P)＞7.32,the area under the curve(AUC)was 0.891,the diagnostic sensitivity was 81.48％and the specificity was 80.41％respectively.Conclusion The early warning factors of ARILI in patients with esophageal cancer treated by IMRT are mainly higher V10,lymph node metastasis,higher V30,basic lung disease,higher V5,higher serum IL-8 level,higher V20 and higher MLD.The regression equation of influencing factors constructed based on this has good predictive value,which can be used to screen high-risk patients and adopt corresponding intervention strategies in clinical practice.