Multivariate analysis and risk prediction model construction of radiation-induced rectal injury in patients with endometrial cancer undergoing pelvic radiotherapy
Objective To analyze the influencing factors of radiation-induced rectal injury(RRI)in endometrial cancer radiotherapy,and construct and validate a risk prediction model.Methods 86 patients with endometrial cancer who underwent pelvic radiotherapy in Oncology Hospital Affiliated to Nantong University from February 2020 to February 2023 were selected.According to the RTOG/EORTC grading,patients with grades 0 to 1 were classified as＜grade 2 RRI group(n=36),while patients with grade 2 to 4 were classified as ≥ grade 2 RRI group(n=50).Univariate and Logistic multivariate regression anal-ysis were used to analyze the high-risk factors for the occurrence of ≥ grade 2 RRI.Results Logistic regression analysis showed that age＞75 years,tumor diameter≥4 cm,clinical stages Ⅲ-Ⅳ,high HAD score(11-21 points)and low SSRS score(＜20 points),mean rectal radiation dose(mean)≥40 Gy,infiltration degree ≥1/2,and radiotherapy time ≥4 weeks were all independent risk factors for ≥ grade 2 RRI in patients with endometrial cancer undergoing radiotherapy(P＜0.05).A risk pre-diction model of ≥ grade 2 RRI after radiotherapy for endometrial cancer was constructed.The Hosmer Lemeshow test(x2=5.138,P＞0.05)showed that the AUC of the predictive model was 0.912,and the 95％CI was 0.856-0.962.It indicated that the model has good fitting and predictive performance in predicting ≥ grade 2 RRI induced by radiotherapy for endometrial canc-er(P＜0.05).Conclusion Endometrial cancer radiotherapy is prone to≥ grade 2 RRI,which may be related to many factors such as patient age,tumor diameter,clinical stage,HAD score,SSRS score,rectal mean ≥40 Gy,degree of infiltration,and radiotherapy time.The model constructed based on various risk factors can effectively predict the probability of ≥ grade 2 RRI after radiotherapy for endometrial cancer.
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