我们引入了一种适应的莱曼正常组织并发症概率 (NTCP) 模型，结合临床风险因素和审查的事件时间数据，来估计左乳腺癌放射治疗 (RT) 后主要不良心脏事件 (MACE) 的风险。回顾性收集2005年至2017年1100名接受术后放疗的左侧乳腺癌女性的特征和MACE数据。使用最大似然估计开发了基于个体左心室 (LV) 等效均匀剂量 (EUD) 的改良广义莱曼 NTCP 模型，考虑了临床风险因素和审查数据。对低合并症组和高合并症组进行了亚组分析。在中位随访 7.8 年中，64 名患者经历了 MACE，受影响个体的平均 LV 剂量较高（4.1 Gy 与 2.9 Gy）。考虑临床因素的完整模型确定 D50 = 43.3 Gy、m = 0.59 和 n = 0.78 作为最佳拟合参数。与低合并症组 (D50 = 45 Gy) 相比，高合并症组 (D50 = 30 Gy) 导致 MACE 概率为 50% 的阈剂量较低。预测表明，将 LV EUD 限制在 5 Gy 以下，高合并症组和低合并症组的 10 年相对 MACE 风险分别低于 1.3 和 1.5。有合并症的患者在乳房放疗后更容易发生心脏事件。拟议的修改后的广义莱曼模型考虑了非剂量风险因素，并解决了晚期并发症的不完整随访问题，提供了 RT 后全面且个性化的 MACE 风险估计。版权所有 © 2024 作者。由爱思唯尔有限公司出版。保留所有权利。

We introduced an adapted Lyman normal-tissue complication probability (NTCP) model, incorporating clinical risk factors and censored time-to-event data, to estimate the risk of major adverse cardiac events (MACE) following left breast cancer radiotherapy (RT).Clinical characteristics and MACE data of 1100 women with left-side breast cancer receiving postoperative RT from 2005 to 2017 were retrospectively collected. A modified generalized Lyman NTCP model based on the individual left ventricle (LV) equivalent uniform dose (EUD), accounting for clinical risk factors and censored data, was developed using maximum likelihood estimation. Subgroup analysis was performed for low-comorbidity and high-comorbidity groups.Over a median follow-up 7.8 years, 64 patients experienced MACE, with higher mean LV dose in affected individuals (4.1 Gy vs. 2.9 Gy). The full model accounting for clinical factors identified D50 = 43.3 Gy, m = 0.59, and n = 0.78 as the best-fit parameters. The threshold dose causing a 50 % probability of MACE was lower in the high-comorbidity group (D50 = 30 Gy) compared to the low-comorbidity group (D50 = 45 Gy). Predictions indicated that restricting LV EUD below 5 Gy yielded a 10-year relative MACE risk less than 1.3 and 1.5 for high-comorbidity and low-comorbidity groups, respectively.Patients with comorbidities are more susceptible to cardiac events following breast RT. The proposed modified generalized Lyman model considers nondosimetric risk factors and addresses incomplete follow-up for late complications, offering comprehensive and individualized MACE risk estimates post-RT.Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.