倾向性评分匹配法对巴塞罗那B期肝细胞癌两种治疗方法的再评价  

Comparison liver resection with transarterial chemoembolization for Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma patients on long-term survival after SPSS propensity score matching

作　　者：柯阳[1] 钟鉴宏[1] 郭哲[1] 梁泳荣[1] 黎乐群[1] 向邦德[1] 

机构地区：[1]广西医科大学附属肿瘤医院肝胆外科,南宁530021

出　　处：《中华医学杂志》2014年第10期747-750,共4页National Medical Journal of China

基　　金：国家科技重大专项课题（2012ZX10002010001009）广西科学研究与技术开发计划项目（桂科攻10124001A-4）

摘　　要：目的经倾向性评分匹配法（PSM）均衡组间协变量后，比较巴塞罗那分期（BCLC）B期肝细胞癌（HCC）患者肝切除术和经动脉化疗栓塞术（TACE）的疗效。方法回顾性分析2000年1月至2007年11月广西医科大学附属肿瘤医院收治的237例BCLC—B期HCC患者的临床资料，其中，手术组167例，TACE组70例，使用SPSS软件PSM功能对两组患者进行匹配，得到组间协变量均衡的样本，并用新样本作生存分析。结果两组共53对匹配成功，生存分析显示手术组和TACE组中位生存时间分别为35．0个月和20．0个月，1、3、5、7年的生存率分别为91．0％、49．0％、30．0％、17．0％与73．0％、25．0％、8．0％、5．O％（P=0．001）。Cox回归分析显示TACE、总胆红素（TBIL）≥34．2lu,m01．／L、甲胎蛋白（AFP）≥400ng／ml、肿瘤个数≥3个是影响BCLC—B期患者生存率的危险因素（HR〉1，P〈0．05）。结论应用PSM能有效提高非随机资料组间协变量的均衡性，对HCC的疗效作出正确评价。BCLC—B期I-／CC患者手术切除病灶较TACE可以获得更大生存收益。Objective To compare the long-term survival of patients with Barcelona Clinic Liver Cancer （BCLC） stage B hepatocellular carcinoma （HCC） undergoing either liver resection or transarterial chemoembolization （TACE） after propensity score matching （PSM）. Methods One hundred sixty-seven and 70 BCLC-B HCC patients undergoing liver resection and TACE were retrospectively collected. PSM function of SPSS software was conducted to reduce confounding bias between the groups. And then survival analysis was performed for the matched data. Results Fifty-three pairs of patients were successfully matched. And then survival analysis showed that the median survival periods and their 95% confidence intervals were 35.0 （26. 3 - 43.7） months in the liver resection group versus 20. 0 （ 15.0 - 25.0） months in the TACE group. The 1, 3, 5 and 7-year survival rates were 91.0%, 49. 0%, 30. 0% and 17. 0% in the liver resection group versus 73.0% , 25.0%, 8.0% and 5.0% respectively in the TACE group （ P = 0. 001 ）. Cox regression analysis revealed that TACE, total bilirubin ≥134. 2 μmol/L, alpha fetoprotein ≥ 400 ng/ml and tumor number≥3 were independent risk factors of survival （hazard ratio 〉 1, P 〈 0. 05）. Conclusion The balance of covariates may be achieved through PSM. And for patients with BCLC-B HCC, liver resection provides better long-term overall survival than TACE.

关 键 词：化学栓塞 治疗性 癌 肝细胞 肝切除术 倾向评分 生存率 

分 类 号：R735.7[医药卫生—肿瘤]