肿瘤患者临床检查中原发肿瘤放化疗后继发异时性肿瘤预测的经验模型

E. L. Shunko, A. Vazhenin, N. Shanazarov
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摘要

本文探讨了应用经验模型预测原发肿瘤放化疗后继发异位肿瘤的可能性,以提高肿瘤患者医学检查的效率。这是一项基于车里雅宾斯克肿瘤和核医学区域临床中心(GBUZ«CHOKZO and YAM»,车里雅宾斯克)存档数据的回顾性研究。研究的主题是1990-2015年期间BSSC«CHOKZO和YAM»癌症患者化疗的医疗记录、医疗和辐射地图、电子数据库,以及从PM ZOH患者治疗数据库中卸载的数据。研究组为168例放化疗后患者,对照组为300例原发肿瘤手术后患者。使用模块«analysis of survival STATISTICA»(«STATISTICA Version 10.0.0.0»)和多因素分析(Cox模型)构建继发性异时性肿瘤的预测模型,考虑所有导致治疗改变的并发症(方案,疗程间隔)。实证模型与研究结果的符合性采用卡方判据(²)进行检验。平均化疗2.83个疗程,放疗1.15个疗程,化疗持续时间3.37个月,放疗持续时间1.87个月。两组治疗间隔时间分别为2.33个月和1.30个月。放化疗并发症80例(47.6%)。我们的预测原发肿瘤放化疗后继发性异时性肿瘤的经验模型显示,在5个时间间隔内继发性异时性肿瘤发生的概率最高:化疗3,804.09-4,564.91天(10.42-12.51年)HR=2.14;风险68.2%;放射治疗HR=2.00;风险66.7%),6847.36 - 7608.18天(18.76-20.84年;化疗组HR=1.75;风险63.6%;放射治疗HR=1.91;风险65.6%),7608.18 - 8369.00天(20.84-22.93年;化疗组HR=1.71;风险63.1%;放疗组HR=1.67;风险62.5%);3,043.27-,3804.09天(8.34-10.42年;放疗组HR=1.92;机会65.9%;化疗组HR=1.35;风险57.45%)、5325.73 ~ 6086.55(14.59 ~ 16.67岁;放射治疗HR=2.00;风险66.70%;化疗组HR=1.56;风险60.94%)。了解原发肿瘤放化疗后第二次异时性肿瘤的时间,可以更精确地制定并在必要时调整每个肿瘤患者在第一次肿瘤放化疗后的门诊观察计划。
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Empirical models for predicting the secondary metachronous tumor after chemoradiation therapy of the primary tumor in the clinical examination of cancer patients
Evaluation of the possibility of applying empirical models for predicting a secondary metachro-nous tumor after chemoradiation therapy of the primary tumor in order to increase the efficiency of cancer patients medical examination were presented. This is the retrospective research based on archived data of the Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine (GBUZ «CHOKZO and YAM», Chelyabinsk). The subjects of the research are medical records, medical and radiation maps, electronic databases on chemoradiation therapy of cancer patients in BSSC «CHOKZO and YAM», unloading from the database on treatment of patients with PM ZOH for the period 1990-2015. The study group contained 168 patients after chemoradiation therapy and a control group of 300 patients after surgery of the primary tumor. Models for predic-tion of the secondary metachronous tumor were constructed with the use of the module «Analy-sis of survival STATISTICA» («Statistica Version 10.0.0.0») and multi-factor analysis (Cox model), all complications that led to changes in treatment (scheme, interval between courses) were taking into account. The compliance of the empirical model with the results of the study was tested by the chi-square criterion (²). On average, the patients received 2.83 courses of chemotherapy and 1.15 courses of radiation therapy, the duration of chemotherapy and radiation therapy was 3.37 months and 1.87 months respectively. The duration of the interval between treatments was 2.33 months and 1.30 months, respectively. Complications of chemoradiotherapy were reported in 80 patients (47.6%). Our empirical models for predicting the secondary metachronous tumor after chemoradiation therapy of the primary tumor demonstrated the highest probability of the sec-ondary metachronous tumor development in five time intervals: 3,804.09-4,564.91 days (10.42-12.51 years) for chemotherapy HR=2.14; risk 68.2%; for radiation therapy HR=2.00; risk 66.7%), 6,847.36-7,608.18 days (18.76-20.84 years; for chemotherapy HR=1.75; risk 63.6%; for radiation therapy HR=1.91; risk 65.6%), 7,608.18-8,369.00 days (20.84-22.93 years; for chemotherapy HR=1.71; risk 63.1%; for radiotherapy HR=1.67; risk 62.5%); 3,043.27-,3804.09 days (8.34-10.42 years; for radiotherapy HR=1.92; chance 65.9%; for chemotherapy HR=1.35; risk 57.45%) and 5,325.73-6,086.55 (14.59-16.67 years; for radiation therapy HR=2.00; risk 66.70%; for chemo-therapy HR=1.56; risk 60.94%). The knowledge of the timing of the second metachronous tumor after chemoradiation therapy of the primary tumor makes it possible to draw up more precisely and, if necessary, adjust the plan of outpatient observation individually for each cancerl patient after chemoradiation treatment of the first tumor.
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