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NSCLC同步放化疗后中性粒细胞减少症风险预测
作者:饶井芬1  于晓磊1  肇爽1  张聪1  冉欣欣2  朱彤1 
单位:1. 承德医学院附属医院 肿瘤科, 河北 承德 067000;
2. 承德医学院附属医院 呼吸与危重症科, 河北 承德 067000
关键词:非小细胞肺癌 同步放化疗 中性粒细胞减少症 随机森林模型 预测价值 影响因素 
分类号:R734.2
出版年·卷·期(页码):2024·43·第二期(209-215)
摘要:

目的: 探讨随机森林模型预测非小细胞肺癌(NSCLC)同步放化疗后中性粒细胞减少症的价值,以期为临床早期预测中性粒细胞减少症发生风险,制定相应干预措施提供参考。方法: 选取2020年1月至2022年8月我院295例NSCLC患者,均接受同步放化疗,根据化疗后是否发生中性粒细胞减少症分为中性粒细胞减少症组(n=91)、非中性粒细胞减少症组(n=204),采用随机数字表法按照2:1比例建立训练集和测试集,构建随机森林预测模型,受试者工作特征(ROC)曲线分析随机森林模型对中性粒细胞减少症的预测效能。结果: 两组年龄、体重、化疗延迟、化疗方案剂量、同步放化疗周期、肠内营养支持、高血压、糖尿病、自身免疫性疾病、预防性应用长效粒细胞集落刺激因子(G-CSF)比较差异有统计学意义(P<0.05);化疗延迟、同步放化疗周期、肠内营养支持、年龄、化疗方案剂量、体重均为中性粒细胞减少症发生的影响因素(P<0.05);基于化疗延迟、同步放化疗周期、肠内营养支持、年龄、化疗方案剂量、体重的随机森林模型预测中性粒细胞减少症发生的ROC曲线下面积(AUC)为0.857,敏感度为80.00%,特异度为95.00%。结论: 基于化疗延迟、同步放化疗周期、肠内营养支持、年龄、化疗方案剂量、体重的随机森林模型对于NSCLC患者同步放化疗后中性粒细胞减少症具有较高评估预测价值,临床可通过上述因素针对性制定干预方案,降低中性粒细胞减少症发生风险。

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.

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