Abstract:

Objective To analyze the early predictive value of serum soluble CD163 （sCD163）， interferon-γ （IFN-γ）， and transforming growth factor-β1 （TGF-β1） for radiation pneumonitis （RP） in non-small cell lung cancer （NSCLC） patients after radiation therapy. Methods One hundred and thirty-two NSCLC patients with clinical stage Ⅲ-Ⅳ receiving radiotherapy at Wuhan Hospital of Traditional Chinese Medicine from December 2020 to November 2023 were selected. Serum sCD163， IFN-γ and TGF-β1 levels were detected by enzyme-linked immunosorbent assay. The occurrence of RP after radiotherapy was analyzed； serum sCD163， IFN-γ， and TGF-β1 levels were compared between NSCLC patients receiving radiotherapy who had RP and those who did not， as well as patients with different levels of RP. Multivariate logistic regression was used to analyze the factors affecting the occurrence of RP in NSCLC patients； the predictive value of serum sCD163， IFN-γ combined with TGF-β1 for the occurrence of RP in patients undergoing radiotherapy for NSCLC was analyzed using reciver operator characteristic （ROC） curves. Results The incidence of RP in NSCLC patients receiving radiotherapy was 24.24% （32/132）. There were 18 cases of grade Ⅱ， 12 cases of grade Ⅲ， 2 cases of grade Ⅳ. Serum sCD163 levels in patients with RP [（94.30±15.78） pg/ml vs. （75.43±13.16） pg/ml， t=6.72， P<0.001]， IFN-γ [（6.52±1.54） pg/ml vs. （4.79±0.94） pg/ml， t=7.65， P<0.001]， TGF-β1 [（9.40±2.63） μg/L vs. （6.30±1.55） μg/L， t=8.18， P<0.001] were significantly higher than those of patients without RP， and there were statistically significant differences. And levels of serum sCD163 [（104.44±15.97） pg/ml vs. （86.41±15.63） pg/ml， t=3.21， P=0.003]， IFN-γ [（7.47±1.56） pg/ml vs. （5.78±1.52） pg/ml， t=3.09， P=0.004] and TGF-β1 [（11.27±2.68） μg/L vs. （7.94±2.59） μg/L， t=3.55， P=0.001] in RP patients with grade Ⅲ-Ⅳ were higher than those in RP patients with grade Ⅱ， and there were statistically significant differences. There were statistically significant differences in radiation dose （χ²=9.25， P=0.002）， V₂₀ （t=6.39， P<0.001） and mean lung dose （MLD） （t=3.57， P<0.001） between patients with and without RP. Multivariate analysis showed that radiation dose （OR=3.98， 95%CI： 2.22-7.15， P<0.001）， V₂₀ （OR=4.75， 95%CI： 2.03-11.15， P<0.001）， MLD （OR=3.15， 95%CI： 1.63-6.09， P=0.001）， sCD163 （OR=4.53， 95%CI： 1.63-12.58， P=0.004）， IFN-γ （OR=5.11， 95%CI： 2.07-12.65， P<0.001）， and TGF-β1 （OR=5.55， 95%CI： 2.99-10.31， P<0.001） were the independent influencing factors for developing RP in patients receiving radiotherapy for NSCLC. The area under the curve （AUC） of sCD163， IFN-γ， and TGF-β1 alone for predicting the occurrence of RP in patients receiving radiotherapy for NSCLC was 0.81 （95%CI： 0.72-0.89）， 0.83 （95%CI： 0.75-0.92） and 0.84 （95%CI： 0.76-0.92）， and the AUC of the above three combined for predicting the occurrence of RP in NSCLC patients receiving radiotherapy was 0.93 （95%CI： 0.88-0.99）， and the combined predictive value of the three was higher than that of sCD163 （Z=2.57， P=0.005）， IFN-γ （Z=2.02， P=0.021）， and TGF-β1 （Z=1.94， P=0.026） alone. Conclusion Serum sCD163， IFN-γ， and TGF-β1 levels are significantly elevated in NSCLC patients undergoing radiotherapy who develop RP， and the combination of the three is of high value in predicting the development of RP in NSCLC patients after radiation therapy.

Key words: Carcinoma， non-small-cell lung, Radiation pneumonitis, Soluble CD163, Interferon-γ, Transforming growth factor-β1