头颈部癌症患者放疗后原发性甲状腺功能减退症：甲状腺剂量-体积限制与长期内分泌结果的外部验证。

Post-radiation primary hypothyroidism in patients with head and neck cancer: External validation of thyroid gland dose-volume constraints with long-term endocrine outcomes.

机构信息

Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region, China.

出版信息

Radiother Oncol. 2022 Dec;177:105-110. doi: 10.1016/j.radonc.2022.10.034. Epub 2022 Nov 3.

DOI:10.1016/j.radonc.2022.10.034

PMID:36336109

Abstract

BACKGROUND

Post-radiation primary hypothyroidism is a common late complication in head and neck cancer (HNC) survivors. No radiation dose-volume constraint of the thyroid gland has been externally validated for predicting long-term thyroid function outcomes.

MATERIALS AND METHODS

This external validation study evaluated the diagnostic properties of 22 radiation dose-volume constraints of the thyroid gland proposed in the literature. Radiation dosimetric data from 488 HNC patients who underwent neck irradiation from January 2013 to December 2015 at two tertiary oncology centers were reviewed. The diagnostic metrics of candidate constraints were computed by inverse probability of censoring weighting and compared using time-dependent receiver operating characteristic (ROC) curves with death designated as a competing event. Multivariable regression analyses were performed using the Fine-Gray sub-distribution hazard model.

RESULTS

Over a median follow-up period of 6.8 years, 205 (42.0 %) patients developed post-radiation primary hypothyroidism. The thyroid volume spared from 60 Gy (VS60) had the largest area under ROC curve of 0.698 at 5 years after radiotherapy. Of all evaluated constraints, VS60 at a cutoff value of 10 cc had the highest F-score of 0.53. The 5-year hypothyroidism risks of patients with thyroid VS60 ≥ 10 cc and < 10 cc were 14.7 % and 38.2 %, respectively (p < 0.001). The adjusted sub-hazard ratio for post-radiation primary hypothyroidism for VS60 < 10 cc was 1.87 (95 % confidence interval, 1.22-2.87; p < 0.001).

CONCLUSION

Thyroid VS60 is the best radiation dose-volume parameter to predict the long-term risk of primary hypothyroidism in patients with HNC who underwent neck irradiation. VS60 ≥ 10 cc is a robust constraint that limits the 5-year primary hypothyroidism risk to less than 15 % and should be routinely employed during radiotherapy optimization.

摘要

背景

放射性后原发性甲状腺功能减退症是头颈部癌症（HNC）幸存者的常见晚期并发症。目前尚无甲状腺的外部放射剂量-体积限制来预测长期甲状腺功能结局。

材料与方法

本外部验证研究评估了文献中提出的 22 种甲状腺放射剂量-体积限制的诊断性能。回顾了 2013 年 1 月至 2015 年 12 月期间在两个三级肿瘤中心接受颈部照射的 488 例 HNC 患者的放射剂量学数据。通过逆概率 censoring 加权法计算候选限制的诊断指标，并通过时间依赖性接收器操作特征（ROC）曲线进行比较，死亡被指定为竞争事件。使用 Fine-Gray 亚分布风险模型进行多变量回归分析。

结果

在中位随访时间 6.8 年后，205 例（42.0%）患者发生放射性后原发性甲状腺功能减退症。在放疗后 5 年内，60Gy 照射的甲状腺体积（VS60）的 ROC 曲线下面积最大，为 0.698。在所有评估的限制中，VS60 在截断值为 10cc 时的 F 评分最高，为 0.53。VS60≥10cc 和 VS60<10cc 的患者 5 年甲状腺功能减退风险分别为 14.7%和 38.2%（p<0.001）。VS60<10cc 的患者发生放射性后原发性甲状腺功能减退的调整后亚风险比为 1.87（95%置信区间，1.22-2.87;p<0.001）。