论文部分内容阅读
目的 评价两种口腔黏膜勾画方法在鼻咽癌患者中预测急性放射性口腔黏膜炎(A-ROM)价值.方法 前瞻性观察分析2017-2019年间浙江省肿瘤医院收治的局部中晚期鼻咽癌150例,所有患者均接受根治性螺旋断层治疗并采用全口腔勾画法(OCC法)和表面黏膜勾画法(MSC法)勾画口腔黏膜.根据RTOG急性放射损伤分级标准每周评估并记录患者的A-ROM分级,比较两种方法对A-ROM的价值.结果 所有患者≥3级A-ROM发生率为33.3％.单因素分析≥3级A-ROM发生的相关剂量学参数包括OCC法的V5、V10、V15、V45、V50、V55、V60、V65、V70和MSC法的V5、V10、V50、V55、V60、V65、V70、Dmean(P均＜0.05).二分类Logistic回归分析发现OCC法的性别、吸烟是≥3级A-ROM的危险因素(男/女:OR=0.141,95％CI为0.037～0.538,P=0.004;吸烟/不吸烟:OR=5.109,95％CI为1.413～18.470,P=0.013).MSC法的性别、吸烟、N分期、V55是≥3级A-ROM的危险因素(男/女:OR=0.129,95％CI为0.032～0.519,P=0.004;吸烟/不吸烟:OR=4.448,95％CI为1.224～16.164,P=0.023;N分期:OR=2.291,95％CI为1.268～ 4.137,P=0.006;V55:OR=1.432,95％CI为1.008～2.033,P=0.045).MSC的V55阈值为7.70％,曲线下面积为0.754,敏感性为0.680,特异性为0.740(P＜0.001).结论 采用螺旋断层治疗鼻咽癌时,MSC法相比OCC法可以更加准确地预测A-ROM的严重程度.“,”Objective To evaluate the value of two oral mucosal contouring methods for predicting acute radiation-induced oral mucositis (A-ROM) in nasopharyngeal carcinoma (NPC) patients.Methods A total of 150 AJCC 7th stage Ⅱ-ⅣB NPCs receiving radical tomotherapy (TOMO) in Zhejiang Cancer Hospital from 2017 to 2019 were included in this prospective observational study.Oral cavity contour (OCC) and mucosal surface contour (MSC) were applied to delineate the oral mucosal structure.A-ROM grade was prospectively assessed and recorded weekly according to RTOG scoring criteria.The prediction value of two methods for A-ROM was statistically compared.Results The incidence rate of ≥ 3 grade A-ROM was 33.3％.In univariate analysis,V5,V10,V15,V45,V50,V55,V60,V65 and V70 of OCC and V5,V10,V50,V55,V60,V65,V70 and Dmean of MSC were significantly correlated with the risk of ≥3 grade A-ROM (all P＜0.05).In binary logistic regression analysis,gender and smoking were significantly associated with the incidence of ≥3 grade A-ROM by using OCC (male vs.female:OR=0.141,95％CI=0.037-0.538,P=0.004;smoking vs.non-smoking:OR=5.109,95％CI=1.413-18.470,P=0.013).For MSC,gender,smoking,N stage and MSC-V55 were the independent predictors (male vs.female:OR=0.129,95％CI=0.032-0.519,P=0.004;smoking vs.non-smoking:OR=4.448,95％CI=1.224-16.164,P=0.023;N stage:OR=2.291,95％CI=1.268-4.137,P=0.006;MSC-V55:OR=1.432,95％CI=1.008-2.033,P=0.045).The cutoff value of MSC-V55 was 7.70％,the area under ROC curve was 0.754,the sensitivity and specificity were 0.680 and 0.740,retrospectively (all P＜0.001).Conclusions Compared with OCC,MSC yields a higher prediction accuracy for the severity of A-ROM in nasopharyngeal carcinoma patients receiving TOMO treatment.