Risk Model Of Liver Damage Caused By Chemotherapy For Nasopharyngeal Carcinoma TP Regimen And Its Empirical Analysis

Objective:Chemotherapy with TP regimen is one of the important treatments for advanced nasopharyngeal carcinoma.At the same time as chemotherapy brings clinical benefits,adverse reactions have been concerned with chemotherapy,such as liver damage after chemotherapy.Severe liver damage increases the economic burden of patients,prolongs the interval between chemotherapy and the start time of radiotherapy,which greatly affects the quality of life and therapeutic efficacy of patients.Prevention of liver damage after chemotherapy is crucial in clinical diagnosis and treatment activities.Therefore,this study provides a basis for predicting liver damage after chemotherapy by establishing a liver damage prediction model,predicting biochemical indicators of liver damage,and clinically verifying its predictive value.Methods:Randomized collection of 102 patients with nasopharyngeal carcinoma who received induction chemotherapy for the first cycle of TP regimen from the first diagnosis of the oncology department of a hospital from September 2014 to December 2018 was used to establish a predictive model based on the Common Terminology Standard for Adverse Events(CTCAE)version 4.0.Hepatotoxicity was graded.The lowest ?100u/L of glutamic acid or aspartate aminotransferase was defined as severe liver dysfunction.20 cases(1)nasopharyngeal carcinoma;(2)pathological type is WHO II-III;(3)age 18-65 years old,male or non-pregnant women;(4)ECOG 0-1 points;(5)Normal aminotransferase and normal renal function;(6)Induction chemotherapy with sufficient TP regimen,no hepatoprotective drugs;(7)After the first TP regimen chemotherapy,the lowest gluten or aspartate aminotransferase ?100u/L was included in the Observation group.82 cases(1)initial nasopharyngeal carcinoma;(2)pathological type is WHO II-III;(3)age 18-65 years old,male or non-pregnant women;(4)ECOG 0-1 points;(5)Normal aminotransferase and normal renal function;(6)Induction chemotherapy withsufficient TP regimen,no hepatoprotective drugs were used;(7)After the first TP regimen chemotherapy,the highest concentration of glutamic acid or aspartate aminotransferase ?40u/L was included in the control group.Record the patient's general information,initial diagnosis,pre-chemotherapy,laboratory examination after chemotherapy.T-test to find these factors were statistically significant included that neutrophil percentage,lymphocyte percentage,fibrinogen concentration,prothrombin time,prealbumin,glutamyl transfer Chymase,creatinine,and uric acid.The above related factors were included in the binary logistic regression model,and the forward method was used for multi-factor statistical analysis to establish a predictive model.To explore the risk factors and independent predictors of severe liver damage caused by chemotherapy in nasopharyngeal carcinoma TP regimen.The ROC curve was used to determine the relative value and optimal selection of the relevant factors and combined diagnostic factors for patients with first-episode TP regimen.Cut off the value.Finally,100 patients were selected for internal empirical analysis of the model.Results:Multivariate regression showed that following factors were statistically significant,include Neut(OR=0.87,95%CI 0.788-0.959,P=0.005)?Fib-g/L(OR=0.247,95%CI 0.083-0.734,P=0.012)? Y-GT(OR=1.442,95%CI 1.015-1.969,P=0.002)Cre(OR=1.55,95%CI 1.001-1.802,P=0.046).ROC analysis showed that the AUC of Neut was 0.704(P = 0.0005),the optimal cutoff value was ? 64.8,the sensitivity was 80%,and the specificity was 56.1%,the AUC of Fib-gL was 0.763(P<0.05),the optimal cutoff value was?3.06,the sensitivity was 100% and specificity was 43.9%.the AUC of Y-GT was 0.665(P=0.021),the optimal cutoff value was >62.09,the sensitivity was 30% and specificity was 98.78%.the AUC of Cre was 0.637(P=0.059),the optimal cutoff value was >77.79,and the sensitivity was 45% and specificity was 81.71%.At the same time.New variables calculated by regression equation(Y= 5.976-0.14*Neut-1.397* Fib-gL + 0.041* Y-GT + 0.049*Cre)called joint predictor,the AUC of which is 0.929(P<0.05),and best truncation value is >-1.6134,which have the sensitivity of 95% and specificity of 74.39%.Another 100 patients were selected for internal medical record verification.The results are: the prediction model has 72.2% sensitivity and 93.7% specificity,thepositive predictive value is 76.5% and the negative predictive value is 92.2%.Have a good reference value.Conclusion:1.The percentage of neutrophils,fibrinogen concentration,glutamine transpepti-dase and creatinine at the time of initial diagnosis are independent predictors of liver damage after chemotherapy with nasopharyngeal carcinoma TP regimen.2.After empirical analysis,the model Y=5.976-0.14* neutrophil percentage-1.397* fibrinogen concentration 0.041*glutamyl transpeptidase 0.049* creatinine has a good predictive value to serious liver function damage after chemotherapy for nasopharyngeal carcinoma TP regimen.