Objective: To explore the value of random forest model in predicting neutropenia in non-small cell lung cancer(NSCLC) after synchronous radiotherapy and chemotherapy, in order to provide reference for early clinical prediction of the risk of neutropenia and the development of corresponding intervention measures. Methods: 295 NSCLC patients were selected from January 2020 to August 2022 in our hospital, all of whom received synchronous radiotherapy and chemotherapy, they were divided into neutropenia group(n=91) and non-neutropenia group(n=204) according to whether neutropenia occurred after chemotherapy, and the random number table method was used to establish the training set and the test set according to the ratio of 2 :1, and the random forest model was constructed. The predictive efficacy of random forest model for neutropenia was analyzed by receiver operating characteristic(ROC) curve. Results: The differences in age, weight, chemotherapy delay, synchronous regimen dose, concurrent radiotherapy and chemotherapy cycle, enteral nutrition support, hypertension, diabetes mellitus, autoimmune disease, and prophylactic granulocyte colony stimulating factor(G-CSF) application between the two groups were statistically significant(P<0.05).Chemotherapy delay, synchronous radiotherapy and chemotherapy cycle, enteral nutrition support, age, chemotherapy regimen dose, and weight were all factors associated with the development of neutropenia(P<0.05). The random forest model based on chemotherapy delay, synchronous radiotherapy and chemotherapy cycle, enteral nutrition support, age, chemotherapy regimen dose, and body weight predicted neutropenia with an AUC of 0.857, sensitivity 80.00%, and specificity 95.00%. Conclusion: A random forest model based on chemotherapy delay, synchronous radiotherapy and chemotherapy cycle, enteral nutrition support, age, chemotherapy regimen dose, and body weight has a high predictive value for assessing neutropenia after synchronous radiotherapy and chemotherapy in patients with NSCLC, and these factors can be used to develop a targeted intervention plan to reduce the risk of neutropenia in the clinic. |
[1] JASPER K,STILES B,MCDONALD F,et al.Practical management of oligometastatic non-small-cell lung cancer[J].J Clin Oncol,2022,40(6):635-641.
[2] DANTOING E,PITON N,SALAVN M,et al.Anti-PD1/PD-L1 immunotherapy for non-small cell lung cancer with actionable oncogenic driver mutations[J].Int J Mol Sci,2021,22(12):6288.
[3] LIU Y,WANG L,SONG Q,et al.Intrapleural nano-immunotherapy promotes innate and adaptive immune responses to enhance anti-PD-L1 therapy for malignant pleural effusion[J].Nat Nanotechnol,2022,17(2):206-216.
[4] MUSTA L,GIC N,BOTEZATU R,et al.Malignant phyllodes tumor of the breast and pregnancy:a rare case report and literature review[J].Medicina (Kaunas),2021,58(1):36.
[5] ZHANG H,ZHOU Y,LI J,et al.The value of DWI in predicting the response to synchronous radiochemotherapy for advanced cervical carcinoma:comparison among three mathematical models[J].Cancer Imaging,2020,20(1):8.
[6] SUZUKI Y,KIKUCHI D,HOTEYA S,et al.Effectiveness of chemoradiotherapy for metachronous esophageal squamous cell carcinoma[J].Digestion,2021,102(4):622-629.
[7] BA Y,SHI Y,JIANG W,et al.Current management of chemotherapy-induced neutropenia in adults:key points and new challenges:Committee of Neoplastic Supportive-Care (CONS),China Anti-Cancer Association Committee of Clinical Chemotherapy,China Anti-Cancer Association[J].Cancer Biol Med,2020,17(4):896-909.
[8] HSIEH C Y,TSAI T F.Drug-induced neutropenia during treatment of non-neoplastic dermatologic diseases:a review[J].Clin Drug Investig,2020,40(10):915-926.
[9] SCHAUER T,HOJMAN P,GEHL J,et al.Exercise training as prophylactic strategy in the management of neutropenia during chemotherapy[J].Br J Pharmacol,2022,179(12):2925-2937.
[10] BLAYNEY D W,ZHANG Q,FENG J,et al.Efficacy of plinabulin vs pegfilgrastim for prevention of chemotherapy-induced neutropenia in adults with non-small cell lung cancer:a phase 2 randomized clinical trial[J].JAMA Oncol,2020,6(11):78-80.
[11] CASSIDY T,HUMPHRIES A R,CRAIG M,et al.Characterizing chemotherapy-induced neutropenia and monocytopenia through mathematical modelling[J].Bull Math Biol,2020,82(8):104.
[12] 李滇,汪旭,鲁小敏.紫杉醇联合铂类同步放化疗治疗鼻咽癌所致中性粒细胞减少影响因素分析及预防用药合理性评价[J].中国药业,2022,31(24):111-115.
[13] MACKEY M C,GLISOVIC S,LECLERC J M,et al.The timing of cyclic cytotoxic chemotherapy can worsen neutropenia and neutrophilia[J].Br J Clin Pharmacol,2021,87(2):687-693.
[14] MOORE D C,GEBRU T,PELLEGRINO A,et al.Neutropenia-associated outcomes in patients with breast cancer receiving myelosuppressive chemotherapy with reduced doses of pegfilgrastim[J].J Pharm Pract,2020,33(6):779-783.
[15] CHEN Q,WU C,ZHAO H,et al.Neo-adjuvant chemotherapy-induced neutropenia is associated with histological responses and outcomes after the resection of colorectal liver metastases[J].J Gastrointest Surg,2020,24(3):659-670.
[16] 陈扬,王巍,张瑞平,等.PEG-rhG-CSF初级预防同步放化疗后中性粒细胞减少的有效性观察[J].中华放射肿瘤学杂志,2021,30(1):66-70.
[17] NOMURA M,MORITA Y,KAKIUCHI A,et al.The association between chemotherapy-induced febrile neutropenia and breast cancer subtype in Japanese patients[J].Int J Clin Pharm,2020,42(1):7-10.
[18] AOKI T,TAKAHASHI H,TANAKA S,et al.Predisposition to prolonged neutropenia after chemotherapy for paediatric acute myeloid leukaemia is associated with better prognosis in the Japanese Paediatric Leukaemia/Lymphoma Study Group AML-05 study[J].Br J Haematol,2021,193(1):176-180.
[19] 董晓荷,杨咏强,赵培峰,等.鼻咽癌和宫颈癌患者同步放化疗单核细胞减少与中性粒细胞减少症关系[J].中华放射肿瘤学杂志,2021,30(1):16-22
[20] KAN M,IMAOKA H,WATANABE K,et al.Chemotherapy-induced neutropenia as a prognostic factor in patients with pancreatic cancer treated with gemcitabine plus nab-paclitaxel:a retrospective cohort study[J].Cancer Chemother Pharmacol,2020,86(2):203-210.
[21] SCHENFELD J R,BENNETT C W,LI S,et al.Trends in use of primary prophylactic colony stimulating factors and neutropenia-related hospitalization in commercially insured patients receiving myelosuppressive chemotherapy in the United States:2005-2017[J].J Oncol Pharm Pract,2021,27(1):128-142.
[22] 董昕,余荣,邓玮,等.预防性使用聚乙二醇化重组人粒细胞集落刺激因子在肺癌患者同步放化疗中的作用[J].中华放射医学与防护杂志,2022,42(11):881-887.
[23] AVERIN A,SILVIA A,LAMERATO L,et al.Risk of chemotherapy-induced febrile neutropenia in patients with metastatic cancer not receiving granulocyte colony-stimulating factor prophylaxis in US clinical practice[J].Support Care Cancer,2021,29(4):2179-2186.
[24] 李祎涵,沈南平,孙霁雯,等.基于自我报告的肿瘤化疗患儿发热性中性粒细胞减少风险预测模型的构建[J].军事护理,2022,39(12):26-29. |