基于倾向性评分逆概率加权法胃癌患者疗效评价  

Effect of different therapy in gastric cancer patients: an evaluation with inverse probability of treatment weighting

作　　者：马洁 冯佳宁 王晓璇 孙娜 许小珊 田野 黄璐 孟维静[1] 王素珍[1] 石福艳 MA Jie;FENG Jia-ning;WANG Xiao-xuan(School of Public Health and Management,Weifang Medical University,Weifang,Shandong Province 261053,China)

机构地区：[1]潍坊医学院公共卫生与管理学院,山东潍坊261053

出　　处：《中国公共卫生》2020年第7期1051-1054,共4页Chinese Journal of Public Health

基　　金：国家自然科学基金(81872719)。

摘　　要：目的基于倾向性评分逆概率加权法(IPTW)评价手术、放疗和联合治疗3种方式治疗胃癌患者的疗效,为胃癌的治疗提供参考依据。方法收集2004年1月—2013年12月美国国家癌症研究所监测、流行病学与预后项目(SEER)数据库中经胃镜病理诊断确诊的7005例胃癌患者数据,其中接受手术治疗者3983例、接受放疗者795例、接受联合治疗者2227例;采用倾向性评分IPTW法以生存时间和结局为效应指标,分析不同的治疗方法对胃癌患者生存率的影响。结果手术组、放疗组和联合治疗组胃癌患者倾向性评分IPTW法加权前中位生存期分别为30、9和38个月,加权后分别为25、11和38个月,加权前、后3组胃癌患者生存曲线间差异均有统计学意义(均P<0.001),联合治疗组患者加权前、后的预后均优于手术组和放疗组患者;加权后大部分基线特征绝对标准化平均差异(ASMD)减小,且均<0.2,3组患者均衡效果较好;在控制了性别、年龄、种族、婚姻状况、肿瘤大小、病理分化、肿瘤分期、T分期、N分期和远处转移情况等混杂因素后,多因素Cox回归分析结果显示,与手术组胃癌患者相比,放疗组胃癌患者的预后较差(HR=2.044,95%CI=1.770~2.361),联合治疗组胃癌患者的预后较好(HR=0.630,95%CI=0.573~0.694)。结论联合治疗方法疗效优于手术和放疗治疗方法。Objective To evaluate the efficacy of radiotherapy,surgery and combined therapy among gastric cancer patients with inverse probability of treatment weighting(IPTW)method.Methods We extracted the data on 7005 pathogenically diagnosed gastric cancer patients(3983 undergoing surgery,795 with radiotherapy,and 2227 receiving combined therapy)from the datasets of Surveillance,Epidemiology,and End Results Program(SEER)of United States for the period from January 2004 through 2013.Then we conducted a retrospective analysis on survival and therapeutic outcome of the patients with IPTW method.Results For the patients with surgery,radiotherapy,and the combined therapy,the median survival time were 30,9,and 38 months before weighted with IPTW and 25,11,and 38 months after weighted with IPTW.There were significant differences in survival curves for the three groups of patients before and after weighted with IPTW(P<0.001 for all).Patients with the combined therapy were better for prognosis than those with surgery or radiotherapy before and after weighting analysis with IPTW.The absolute standardized mean difference(ASMD)for survival analysis results weighted by IPTW for the three patients groups were all less than 0.2,indicating a balanced weighting effect among the three patient groups.Cox multivariate regression analysis demonstrated that compared with those with surgery,the patients with radiotherapy had a poor prognosis(hazard risk[HR]=2.044,95%confidence interval[95%CI]:1.770–2.361),whereas the patients with the combined therapy had a better prognosis(HR=0.630,95%CI:0.573–0.694)after adjusting for confounders such as gender,age,race,marital status,tumor size,pathogenically differentiated degree,tumor stage,and tumor-node-metastasis(TNM)staging.Conclusion The prognosis of gastric cancer patients with combined therapy is better than the patients with surgery or radiotherapy.

关 键 词：胃癌患者 倾向性评分 逆概率加权法(IPTW) 疗效 评价 

分 类 号：R181[医药卫生—流行病学]