A Meta-Analysis-Based Risk Score for Predicting Radiation Pneumonitis After Thoracic Radiation Therapy for Lung Cancer
Abstract
Purpose: To develop and validate a risk score for predicting radiation pneumonitis (RP) in lung cancer patients following thoracic radiation therapy.
Methods and materials: The linear predictor was first derived from a meta-analysis. Risk factors with consistent definitions and statistical significance were identified, and their pooled odds ratios were converted to β-coefficients and then linearly transformed to construct the initial scoring items. An independent Asian calibration cohort (cohort 1, n = 218) was used to estimate the model's intercept and to determine the optimal risk stratification cut-off via receiver operating characteristic analysis. The discrimination capability and clinical applicability of the model were subsequently evaluated in 2 independent Asian external validation cohorts (cohort 2, n = 69; cohort 3, n = 81). The primary endpoint was grade ≥2 RP (National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0).
Results: The final score for predicting RP included 7 variables: smoking, chemotherapy, tumor location, pulmonary comorbidities, use of renin-angiotensin system inhibitors, percentage of lung volume receiving ≥5 Gy (V5), and percentage of lung volume receiving ≥20 Gy (V20), with a total possible score of 107. It demonstrated an area under the curve of 0.831 (95% CI, 0.768-0.894) in the calibration cohort, establishing 53.5 points as the optimal cut-off value for risk stratification. Discriminative performance remained…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 218 participants or records.
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