연세의대 / 박예인, 홍채선*, 최서희*
Abstract
Purpose: We aimed to develop Lyman-Kutcher-Burman (LKB) and multivariable normal tissue complication probability (NTCP) models to predict the risk of radiation-induced hypothyroidism (RIHT) in breast cancer patients.
Materials and methods: A total of 1,063 breast cancer patients who underwent whole breast irradiation between 2009 and 2016 were analyzed. Individual dose-volume histograms were used to generate LKB and multivariable logistic regression models. LKB model was fit using the thyroid radiation dose-volume parameters. A multivariable model was constructed to identify potential dosimetric and clinical parameters associated with RIHT. Internal validation was conducted using bootstrapping techniques, and model performance was evaluated using the area under the curve (AUC) and Hosmer-Lemeshow (HL) goodness-of-fit test.
Results: RIHT developed in 4 % of patients with a median follow-up of 77.7 months. LKB and multivariable NTCP models exhibited significant agreement between the predicted and observed results (HL P values > 0.05). The multivariable NTCP model outperformed the LKB model in predicting RIHT (AUC 0.62 vs. 0.54). In the multivariable model, systemic therapy, age, and percentage of thyroid volume receiving ≥ 10 Gy (V10) were significant prognostic factors for RIHT. The cumulative incidence of RIHT was significantly higher in patients who exceeded the cut-off values for all three risk predictors (systemic therapy, age ≥ 40 years, and thyroid V10 ≥ 26 %, P < 0.005).
Conclusions: Systemic therapy, age, and V10 of the thyroid were identified as strong risk factors for the development of RIHT. Our NTCP models provide valuable insights to clinicians for predicting and preventing hypothyroidism by identifying high-risk patients.
Affiliations
Ye-In Park 1, Min-Seok Cho 2, Jee Suk Chang 1 3, Jin Sung Kim 1, Yong Bae Kim 1, Ik Jae Lee 1, Chae-Seon Hong 1, Seo Hee Choi 1
1Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
2Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi do, South Korea.
3BC Cancer - Vancouver Centre, Vancouver, British Columbia, Canada.
편집위원
유방암 방사선치료 후 갑상선기능저하증 발생률을 multivariable NTCP model을 이용하여 분석한 결과로, systemic therapy, age, thyroid V10Gy가 유의한 인자로 분석되었음.
2024-03-28 11:08:41
편집위원2
수술 후 방사선치료를 받은 유방암 환자 1063명 중 61.5%가 regional LN (level 4 in 18.1% and SCL 43.5%)포함하여 방사선치료를 받았을 때 4%에서 hypothyroidism를 보고하였습니다.
2024-03-28 11:09:06