精准医学杂志 (Dec 2023)
RISK FACTORS FOR NEUTROPENIA DURING POSTOPERATIVE ADJUVANT RADIOTHERAPY FOR BREAST CANCER
Abstract
Objective To explore the risk factors for neutropenia (grade 2 or higher) during postoperative adjuvant radiotherapy for breast cancer. Methods A total of 93 patients with breast cancer treated by postoperative adjuvant radiotherapy in Shaanxi Provincial People’s Hospital from January 2018 to December 2020 were assigned to a control group (no neutropenia or grade 1 neutropenia, n=62) and an observation group (grade 2 or higher neutropenia, n=31). The clinical data of the two groups were analyzed by univariate and logistic regression analyses to determine the independent risk factors for grade 2 or higher neutropenia, and the predictive efficacy of risk factors was established by the receiver operating characteristic (ROC) curve. Results The univariate analysis results showed that there were significant differences between the two groups in molecular types of breast cancer, white blood cell count and absolute neutrophil count at the first visit, proportion of patients with grade 4 myelosuppression during chemotherapy, white blood cell count, absolute neutrophil count, hemoglobin before radiotherapy, planning target volume (PTV), mean radiotherapy dose to the sternum (Dmean), and ratio of volume exposed to radiation greater than 20 Gy to total vo-lume and ratio of volume exposed to radiation greater than 30 Gy to total volume in the sternum (χ2=4.511,9.900,t=2.286-9.900,P<0.05). The logistic regression analysis results showed that PTV and sternum Dmean were independent risk factors for grade 2 or higher neutropenia (P<0.05). The ROC curves showed a cut-off value of 733.28 mL for PTV, with an area under the curve (AUC) of 0.664, a sensitivity of 83.9%, and a specificity of 56.5%, and a cut-off value of 2 213.5 cGy for sternum Dmean, with an AUC of 0.749, a sensitivity of 80.6%, and a specificity of 67.7%; the AUC of the two indices for the combined prediction of grade 2 or higher neutropenia was 0.786, with a sensitivity of 96.8% and a specificity of 58.4%. Conclusion PTV >733.28 mL and sternum Dmean >2 213.5 cGy are independent risk factors for grade 2 or higher neutropenia during postoperative adjuvant radiotherapy for breast cancer, and the combination of the two indices can improve the predictive efficacy for the occurrence of neutropenia.
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