Analysis of Risk Factors for Acute Radiation Pneumonitis in Cases with Esophageal Squamous Cell Carcinoma Undergoing Intensity-Modulated Radiotherapy and Construction of A Prediction Model
SU Wanghui
HE Yun
LI Fang
PAN Jiyuan
MENG Xin
HUANG Yuanqing
LI Yi
Abstract：Objective To explore the risk factors for acute radiation pneumonitis(ARP)in patients with esophageal squamous cell carcinoma undergoing intensity-modulated radiotherapy and to construct a prediction model.Methods A total of 206 patients with esophageal squamous cell carcinoma who received intensity-modulated radiotherapy in the Second Affiliated Hospital of Xi'an Jiaotong University from February 2018 to January 2025 were retrospectively included.They were divided into the ARP group(75 cases)and the non-ARP group(131 cases)based on ARP occurrence.General clinical data were compared between groups.Multivariate Logistic stepwise regression analysis was used to identify influencing factors for ARP.A nomogram model was constructed and its predictive value was evaluated.Results The proportions of diabetes,clinical stage(Ⅲ-Ⅳ),and lymph node metastasis,mean lung dose(MLD),V5 and V20 of both lungs,and C-reactive protein(CRP)levels in the ARP group were significantly higher than in the non-ARP group,while lymphocyte and albumin levels in the ARP group were significantly lower than that in the non-ARP group(P<0.05).Multivariate Logistic stepwise regression analysis showed that diabetes,lymph node metastasis,MLD,V5 of both lungs,and CRP were independent risk factors for ARP(OR=1.853,95%CI:1.357-2.531,P<0.001;OR=2.065,95%CI:1.457-2.927,P<0.001;OR=2.568,95%CI:1.685-3.913,P<0.001;OR=2.762,95%CI:1.816-4.201,P<0.001;OR=2.641,95%CI:1.736-4.017,P<0.001).The nomogram showed a consistency index of 0.903(95%CI:0.849-0.957).Hosmer-Lemeshow test indicated no overfitting(χ2=0.753,P=0.429),with the calibration curve approximating the ideal line.The AUC for ARP prediction was 0.882(95%CI:0.829-0.935),with 68.16%specificity and 91.58%sensitivity.Conclusion Diabetes,lymph node metastasis,MLD,V5 of both lungs,and CRP levels are risk factors for ARP in cases with esophageal squamous cell carcinoma undergoing intensity-modulated radiotherapy.The nomogram model constructed based on these factors has certain predictive value for ARP.
Keywords：Esophageal squamous cell carcinomaIntensity-modulated radiotherapyAcute radiation pneumonitisRisk factorsNomogram
Publication Date：2025-07-20
Online Publishing Date：2025-08-27(First online date of this platform, not the publication date of the document)
Pages：6( 35-40 )