关键词: 乳腺肿瘤, 化放疗, 放射性皮炎, 高压氧

Abstract:

Objective To analyze the factors affecting the efficacy of hyperbaric oxygen chamber in treating acute radiation dermatitis （ARD） caused by breast cancer radiotherapy， and to construct a nomogram prediction model. Methods A total of 720 breast cancer patients who underwent modified radical mastectomy and radiotherapy in the Department of Radiation Oncology of the First Affiliated Hospital of Hebei North University from December 2021 to December 2024 were selected as research subjects. Using the random drawing method， patients were divided into the model group （n=504） and the validation group （n=216） in a ratio of 7∶3. On the basis of conventional ARD prevention measures， the patients received 15 sessions of hyperbaric oxygen chamber therapy. At week 7， multivariate logistic regression was used to analyze the influencing factors for patients with ARD grade 1 in the model group. A efficacy nomogram prediction model was constructed. The model's consistency was assessed using the C-index and calibration curves. Receiver operator characteristic （ROC） curve was plotted for patients with grade 1 ARD in both the model group and the validation group， and the area under the curve （AUC） was compared between groups using the DeLong test. Results There were statistically significant differences in age （t=-9.05， P<0.001）， history of chemotherapy （χ²=4.47， P=0.035）， hypertension （χ²=5.40， P=0.020）， diabetes （χ²=5.34， P=0.021）， microcirculation disorder （χ²=4.14， P=0.042）， and arteriosclerosis （χ²=4.12， P=0.042） between patients with grade 1 and grade 2 or above ARD at the 7th week of radiotherapy. Multivariate analysis revealed that age （OR=1.56， 95%CI： 1.09-1.93， P=0.031）， history of chemotherapy （OR=2.30， 95%CI： 1.66-4.78， P<0.001）， hypertension （OR=1.79， 95%CI： 1.24-2.78， P=0.026）， diabetes （OR=1.88， 95%CI： 1.39-3.25， P=0.019）， microcirculation disorder （OR=2.15， 95%CI： 1.58-4.46， P=0.004）， and atherosclerosis （OR=2.01， 95%CI： 1.49-4.27， P=0.010） were all independent influencing factors for grade 1 ARD in breast cancer patients at the 7th week of radiotherapy after radical mastectomy. The C-index of the nomogram prediction model constructed based on the above factors was 0.862 （95%CI： 0.824-0.895）， and the calibration curve showed good consistency （χ²=5.89， P=0.177）. The AUCs of the nomogram model for predicting grade 1 ARD in breast cancer patients at the 7th week of radiotherapy after radical mastectomy in the model group and validation group were 0.852 and 0.839， respectively， with no statistically significant difference （Z=0.48， P=0.328）. Conclusions For patients aged 51 or younger， without a history of chemotherapy， without hypertension， without diabetes， without microcirculation disorders， without arteriosclerosis， and who have developed ARD after radical mastectomy for breast cancer， hyperbaric oxygen chamber therapy demonstrates a relatively favorable therapeutic outcome. A nomogram prediction model developed based on the above factors is helpful for timely and accurately screening patients suitable for this intervention， offering certain clinical applicability and reference value.

Key words: Breast neoplasms, Chemoradiotherapy, Radiodermatitis, Hyperbaric oxygen