【摘要】 目的 探讨局部进展期直肠癌患者行同步放化疗期间发生急性骨髓抑制的影响因素。方法 收集62例局部进展期直肠癌患者的临床资料，患者均接受卡培他滨化疗联合盆腔调强放疗。同步放化疗期间评估患者发生急性骨髓抑制情况，并将发生2级及以上急性骨髓抑制的患者纳入抑制组，其余患者纳入非抑制组。比较两组患者的临床资料和剂量体积参数。采用多因素Logistic回归模型分析局部进展期直肠癌患者放化疗期间发生2级及以上急性骨髓抑制的影响因素，采用受试者工作特征（ROC）曲线计算患者发生急性骨髓抑制的剂量体积参数阈值。结果 62例局部进展期直肠癌患者同步放化疗期间的2级及以上急性骨髓抑制的发生率为37.1%（23/62）。抑制组患者的女性比例，髂骨V₅、V₁₀、V₁₅、V₂₀、V₂₅,腰骶骨V₄₅,骨盆下部V₃₀、V₃₅、V₄₀、V₄₅,以及骨盆V₁₅、V₂₀、V₂₅、V₃₀均高于非髓抑制组（均P<0.05）。Logistic回归分析结果显示，腰骶骨V₄₅是局部进展期直肠癌患者同步放化疗期间发生2级及以上急性骨髓抑制的独立危险因素（P<0.05）。ROC曲线结果显示腰骶骨V₄₅评估患者发生2级及以上急性骨髓抑制的曲线下面积为0.697,阈值为40%,敏感性为0.739,特异性为0.718。腰骶骨V₄₅≥40%的患者的2级及以上急性骨髓抑制发生率较高（P<0.05）。结论 局部进展期直肠癌患者同步放化疗期间急性骨髓抑制的发生率较高，腰骶骨V₄₅是患者发生急性骨髓抑制的独立危险因素。临床上应将腰骶骨V₄₅降低至40%以下，以减少2级及以上急性骨髓抑制的发生。更多还原

【Abstract】 Objective To explore the influencing factors for the occurrence of acute myelosuppression during concurrent radiochemotherapy in patients with locally advanced rectal cancer. Methods The clinical data of 62 patients with locally advanced rectal cancer were collected. All the patients received chemotherapy with capecitabine combined with pelvic intensity-modulated radiotherapy. The occurrence of acute myelosuppression was evaluated during cocurrent radiochemotherapy, and the patients suffering from acute myelosuppression in grade 2 and above were enrolled in the suppression group, and the remaining patients were enrolled in the non-suppression group. The clinical data and dose-volume parameters were compared between the two groups. The multivariate Logistic regression model was performed to analyze the influencing factors for the occurrence of acute myelosuppression in patients with locally advanced rectal cancer during radiochemotherapy, and the receiver operating characteristic（ROC） curve was used to calculate the dose-volume parameter threshold for patients suffering from acute myelosuppression.Results The incidence rate of grade 2 and above acute myelosuppression in 62 patients with locally advanced rectal cancer during concurrent radiochemotherapy was 37.1%（23/62）. The suppression group exhibited a higher proportion of females, and higher ilium V₅, V₁₀, V₁₅, V₂₀, V₂₅, lumbosacral bone V₄₅, lower part of the pelvis V₃₀, V₃₅, V₄₀, V₄₅, and pelvics V₁₅, V₂₀, V₂₅, V₃₀ as compared with the non-suppression group（all P<0.05）. The results of Logistic regression analysis revealed that lumbosacral bone V₄₅ was an independent risk factor for the occurrence of grade 2 and above acute myelosuppression in patients with locally advanced rectal cancer during concurrent radiochemotherapy（P<0.05）. The ROC curve results interpreted that the area under the curve of lumbosacral bone V₄₅ in evaluating the occurrence of grade 2 and above acute myelosuppression in patients was 0.697, the threshold was 40%, the sensitivity was 0.739, and the specificity was 0.718. The incidence rate of grade 2 and above acute myelosuppression was higher in the patients with lumbosacral bone V₄₅≥40%（P<0.05）. Conclusion The incidence rate of acute myelosuppression in patients with locally advanced rectal cancer during concurrent radiochemotherapy is high. The lumbosacral bone V₄₅ is an independent risk factor for the occurrence of acute myelosuppression. Clinically, the lumbosacral bone V₄₅ should be reduced to less than 40%, so as to reduce the occurrence of grade 2 and above acute myelosuppression.更多还原