中华放射医学与防护杂志
中華放射醫學與防護雜誌
중화방사의학여방호잡지
Chinese Journal of Radiological Medicine and Protection
2012年
5期
505-508
,共4页
王冬青%张建%李宝生%孙洪福
王鼕青%張建%李寶生%孫洪福
왕동청%장건%리보생%손홍복
非小细胞肺癌%剂量体积直方图%放射性肺炎%受试者工作特征曲线
非小細胞肺癌%劑量體積直方圖%放射性肺炎%受試者工作特徵麯線
비소세포폐암%제량체적직방도%방사성폐염%수시자공작특정곡선
Non-small cell lung cancer%Dose-volume histogram%Radiation pneumonitis
目的 应用受试者工作特征曲线(ROC)对剂量体积直方图参数(DVH)预测放射性肺炎(RP)进行分析,探究DVH参数预测RP的准确性(ACC)、敏感性(SEN)和特异性(SPE).方法 收集118例接受三维适形调强放疗和化疗的非小细胞肺癌患者资料,回顾分析三维放疗计划系统中双肺V5、V10、V13、V20、V30(Vx为接受≥x Gy的相对肺体积)和平均肺剂量(MLD)与治疗后出现≥2级RP(CTCAE3.0)的相关性.对上述DVH参数应用ROC曲线进行回顾性分析,确定预测RP的ACC、SEN和SPE.结果 单因素分析显示,双肺V5、V10、V13、V20和MLD均与RP发生显著相关(x2=4.786、5.771、6.366、7.367、6.945,P＜0.05)；双肺V30、患者因素(年龄、性别、KPS评分、肿瘤位置、病理类型)和治疗因素(放疗总剂量、照射技术、化疗方案、化疗时机)与RP的发生风险无显著相关性.多因素分析显示双肺V20与RP发生风险相关(x2=10.96,OR =4.16,95％ CI 1.40～12.36,P＜0.05),与其他DVH参数具有显著共线性(r=0.767～0.902,P＜0.05).ROC曲线证实双肺V20能够预测RP的发生(Z=2.038,P＜0.05),其预测的ACC、SEN和SPE分别为0.645(95％CI 0.498 ～0.793),0.650(95％ CI 0.408 ～0.864)和0.674(95％ CI 0.571～0.765),其阳性预测值仅为28.9％.结论双肺V20与RP的发生风险相关,能够预测RP的发生,但是预测能力有限.
目的 應用受試者工作特徵麯線(ROC)對劑量體積直方圖參數(DVH)預測放射性肺炎(RP)進行分析,探究DVH參數預測RP的準確性(ACC)、敏感性(SEN)和特異性(SPE).方法 收集118例接受三維適形調彊放療和化療的非小細胞肺癌患者資料,迴顧分析三維放療計劃繫統中雙肺V5、V10、V13、V20、V30(Vx為接受≥x Gy的相對肺體積)和平均肺劑量(MLD)與治療後齣現≥2級RP(CTCAE3.0)的相關性.對上述DVH參數應用ROC麯線進行迴顧性分析,確定預測RP的ACC、SEN和SPE.結果 單因素分析顯示,雙肺V5、V10、V13、V20和MLD均與RP髮生顯著相關(x2=4.786、5.771、6.366、7.367、6.945,P＜0.05)；雙肺V30、患者因素(年齡、性彆、KPS評分、腫瘤位置、病理類型)和治療因素(放療總劑量、照射技術、化療方案、化療時機)與RP的髮生風險無顯著相關性.多因素分析顯示雙肺V20與RP髮生風險相關(x2=10.96,OR =4.16,95％ CI 1.40～12.36,P＜0.05),與其他DVH參數具有顯著共線性(r=0.767～0.902,P＜0.05).ROC麯線證實雙肺V20能夠預測RP的髮生(Z=2.038,P＜0.05),其預測的ACC、SEN和SPE分彆為0.645(95％CI 0.498 ～0.793),0.650(95％ CI 0.408 ～0.864)和0.674(95％ CI 0.571～0.765),其暘性預測值僅為28.9％.結論雙肺V20與RP的髮生風險相關,能夠預測RP的髮生,但是預測能力有限.
목적 응용수시자공작특정곡선(ROC)대제량체적직방도삼수(DVH)예측방사성폐염(RP)진행분석,탐구DVH삼수예측RP적준학성(ACC)、민감성(SEN)화특이성(SPE).방법 수집118례접수삼유괄형조강방료화화료적비소세포폐암환자자료,회고분석삼유방료계화계통중쌍폐V5、V10、V13、V20、V30(Vx위접수≥x Gy적상대폐체적)화평균폐제량(MLD)여치료후출현≥2급RP(CTCAE3.0)적상관성.대상술DVH삼수응용ROC곡선진행회고성분석,학정예측RP적ACC、SEN화SPE.결과 단인소분석현시,쌍폐V5、V10、V13、V20화MLD균여RP발생현저상관(x2=4.786、5.771、6.366、7.367、6.945,P＜0.05)；쌍폐V30、환자인소(년령、성별、KPS평분、종류위치、병리류형)화치료인소(방료총제량、조사기술、화료방안、화료시궤)여RP적발생풍험무현저상관성.다인소분석현시쌍폐V20여RP발생풍험상관(x2=10.96,OR =4.16,95％ CI 1.40～12.36,P＜0.05),여기타DVH삼수구유현저공선성(r=0.767～0.902,P＜0.05).ROC곡선증실쌍폐V20능구예측RP적발생(Z=2.038,P＜0.05),기예측적ACC、SEN화SPE분별위0.645(95％CI 0.498 ～0.793),0.650(95％ CI 0.408 ～0.864)화0.674(95％ CI 0.571～0.765),기양성예측치부위28.9％.결론쌍폐V20여RP적발생풍험상관,능구예측RP적발생,단시예측능력유한.
Objective To assess the accuracy (ACC),sensitivity (SEN),and specificity (SPE) of dose-volume histogram (DVH) parameters in predicting the radiation pneumonitis (RP) using receiver operating characteristic (ROC) curve.Methods Complete clinical data of 118 non-small cell lung cancer patients treated with three-dimensional conformal and intensity-modulated radiotherapy plus chemotherapy were included.Chi-square and logistic regression were retrospectively applied to analyze the correlations between DVH parameters [relative lung volume received ≥ 5 Gy (V5),10 Gy (V10),13 Gy(V13),20 Gy (V20) and 30 Gy (V30) and mean lung dose (MLD)] and grade 2 (and above) RP defined by the National Cancer Institute Common Terminology Criteria for Adverse Events,version 3.0.ROC curve was adopted to investigate the predictive ACC,SEN and SPE of potential DVH parameters associated with RP.Results Total lungs V5,V10,V13,V20 and MLD were all correlated to the development of RP (x2 =4.786,5.771,6.366,7.367 and 6.945,P ＜ 0.05) according to univariate analysis.However,total lungs V30,patient characteristics (age,sex,KPS,tumor location,pathology) and treatment factors (prescription dose,radiotherapy technique,chemotherapy method and timing) were not contributors to RP.Logistic regression showed that V20 of both lungs remains tight by associated with RP (x2 =10.96,OR =4.16,95％ CI 1.40 ～ 12.36,P ＜0.05),although significant colinearity was found between V20 and other DVH parameters (r =0.767-0.902,P ＜0.05).ROC curve confirmed that V20 of both lungs could act as a predictor for RP (Z =2.038,P ＜ 0.05).The predictive ACC,SEN,and SPE were 0.645 (95％ CI0.498-0.793),0.650 (95％ CI0.408-0.864),and 0.674 (95％ CI0.571-0.765),respectively.However,the positive predictive value was only 28.9％.Conclusions V20 of both lungs was correlated to the development of RP.It could act as a predictor for RP though the predictability is limited.
