构建中老年食管癌患者调强放射治疗(IMRT)期间放射性肺损伤(RILT)风险模型，并探索其应用价值。

选取徐州医科大学附属沭阳医院2018年1月至2023年1月收治的194例拟行IMRT的中老年食管癌患者，按照3∶1分别纳入模型组(n＝145)、验证组(n＝49)。记录2组患者RILT发生率，使用Logistic多因素回归分析，总结影响模型组患者RILT发生的风险因素，并基于风险因素建立Nomogram预测模型；计算模型组、验证组模型应用效能，并使用Kolmogorov-Smimov拟合优度检验、决策曲线分析，评估模型校准度和净收益率。

模型组RILT发生率为14.48%(21/145)，验证组为16.33%(8/49)，组间比较差异无统计学意义(χ²＝0.098，P＝0.754)。Logistic多因素回归模型分析显示，年龄≥65岁、KPS评分<80分、放疗总剂量≥50 Gy、同步化疗、合并糖尿病，以及肺V₅≥55%、V₁₀≥38%、V₂₀≥28%、V₃₀≥20%、肺平均剂量≥13 Gy，均为导致中老年食管癌患者IMRT期间RILT发生的独立风险因素(P均<0.05)。基于风险因素分析建立的Nomogram模型的效能良好，Kolmogorov-Smimov拟合优度检验示模型校准度佳(χ²＝5.604，P＝0.779)，决策曲线分析示该模型区分度良好。

中老年食管癌患者IMRT期间RILT发生风险较高，与患者年龄、活动能力、治疗方案、合并症、肺放射计量学等多种因素有关，基于上述因素建立的预测模型能够为RILT风险预测提供可靠参考，开展风险评估并施加干预能够取得良好获益。

To construct a risk model of radiation-induced lung injury(RILT)in middle-aged and elderly patients with esophageal cancer during intensity-modulated radiotherapy(IMRT), and to explore its application value.

From January 2018 to January 2023, 194 middle-aged and elderly patients with esophageal cancer who were treated with IMRT were selected from the Affiliated Shuyang Hospital of Xuzhou Medical University, and were divided into model group(n=145)and verification group(n=49)according to the ratio of 3∶1.The incidence of RILT in the two groups was recorded, and the risk factors affecting the occurrence of RILT in the model group were summarized by Logistic multivariate regression analysis, and the Nomogram prediction model was established based on the risk factors.The application efficiency of the model group and verification group was calculated, and Kolmogorov-Smimov goodness-of-fit test and decision curve analysis were used to evaluate the model calibration and net yield.

The incidence of RILT was 14.48%(21/145)in the model group and 16.33%(8/49)in the verification group, and there was no statistical difference between the two groups(χ²=0.098, P=0.754). Logistic multivariate regression model analysis showed that age≥65 years, KPS score<80, total radiation dose≥50 Gy, concurrent chemotherapy, diabetes, and lung V₅≥55%, V₁₀≥38%, V₂₀≥28%, V₃₀≥20%, and average lung dose≥13 Gy were all independent risk factors for RILT during IMRT in middle-aged and elderly patients with esophageal cancer(all P<0.05). The Nomogram model based on risk factor analysis had good efficiency, Kolmogorov-Smimov goodness-of-fit test showed that the model had good calibration(χ²=5.604, P=0.779), and decision curve analysis showed that the model had good discrimination.

The risk of RILT in middle-aged and elderly patients with esophageal cancer during IMRT is high, and it is related to many factors, such as age, mobility, treatment plan, complications, lung dosimetry and so on.The prediction model based on the above factors can provide reliable reference for RILT risk prediction, and risk assessment and intervention can gain good benefits.