晚期非小细胞肺癌根治术后放疗价值的倾向评分匹法评价  

Evaluation of the value of postoperative radiotherapy for advanced non-small cell lung cancer by propensity score matching

作　　者：刘冬梅 刘新菊 邱荣良 王突 谭波 张景伟 LIU Dong-mei;LIU Xin-ju;QIU Rong-liang;WANG Wen;TAN Bo;ZHANG Jing-wei(Department of Radiation Oncology Affiliated Cancer Hospital of Zhengzhou University,Henan Cancer Hospital Zhengzhou 450008,China)

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院放疗科,河南郑州450008

出　　处：《中华肿瘤防治杂志》2021年第9期688-693,共6页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的-探讨DIA(N_(2))期非小细胞肺癌根治术后辅助放疗(PORT)的作用及获益人群。方法收集2009-01-01-2015-12-31在河南省肿瘤医院接受根治性手术且行术后辅助治疗的300例IQA(N_(2))期非小细胞肺癌患者的临床资料,按治疗方法不同,应用倾向评分匹配法均衡组间协变量差异分为PORT(+)组和PORT(-)组各84例,采用Kaplan-Meier法进行生存分析,组间比较采用Logrank法,以Cox比例风险模型进行多因素分析。观察2组患者的生存率、无进展生存率、无远处转移生存率和局部控制率。结果匹配后PORT(+)组1、3和5年生存率分别为8&1%、56.3%和32.1%,PORT(-)组分别为75.2%,33.7%和16.6%,差异有统计学意义,χ^(2)=10.207,P=0.001。PORT(+)组1、3和5年无进展生存率分别为84.1%、47.2%和26.7%,PORT(-)组分别为75.6%.27.5%和16.6%,差异有统计学意义χ^(2)=6.922,P=0.009。PORT(+)组1、3、5年无远处转移率分别为83.6%,34.1%、25.1%,PORT(-)组分别为78.8%、30.8%、21.1%,差异无统计学意义,χ^(2)=1.004,P=0.316O PORT(+)组1、3、5年局部控制率分别为85.5%、59.8%、27.8%,PORT(-)组分别为63.6%、40.2%、16.4%,差异有统计学意义,χ^(2)=7.307,P=0.007。亚组分析发现,术后放疗生存获益的亚组为隆突下淋巴结阳性组(χ^(2)=4.146,P=0.024)、N_(2)阳性淋巴结多站转移组(χ^(2)=3,914,P=0.031)。局部控制获益的亚组为N_(2)阳性淋巴结多站转移(χ^(2)=5.612,P=0.018)、隆突下淋巴结阳性(χ^(2)=3,345,P=0.043)、术后8分期组(χ^(2)=4.142,P=0.032)。结论术后辅助放疗提高IA(N_(2))期非小细胞肺癌的生存率,降低局部复发率。亚组分析中N_(2)阳性淋巴结多站转移、隆突下淋巴结阳性、术洁T_(3)分期者获益较大。Objective To investigate the effect of postoperative radiotherapy in the patients treated with curative surgery in stage HI A-N_(2) non-small cell lung cancer(NSCLC)and its beneficiaries.Methods The clinical data of 300 patients with stage IH A-N_(2) non-small cell lung cancer who was treated with radical surgery form 2009.01.01 to 2015.12.31 were retrospectively analyzed.The patients were divided into PORT(+)group and PORT(-)group according to the treatment method.Propensity score matching analysis was used to balance the variables differences between the groups.Kaplan-Meier method was used to analyze the survival.-Difference between groups was compared by Log-rank test,and Cox model was used for multivariate analysis.The survival rate,progression-free survival rate,distant metastasis-free survival rate and local control rate were observed.The role of postoperative radiotherapy and the subgroups that benefited from postoperative radiotherapy were analyzed.Results After propensity scores matching,the 1-,3-and 5-year overall survival rates of PORT(+)and PORT(-)were 1%,56.3%,32.1%and 75.2%,33.7%,16.6%,respectively(χ^(2)=10.207,P=0.001).The 1-,3-and 5-year progression free survival rates were 84.1%,47.2%,26.7%and 75.6%,27.5%,16.6%,respectively(χ^(2)=6.922,P=0.009).The 1-,3-and 5-year distant metastasis free survival rates were 83.6%,34.1%,25.1%and 7&8%,30.8%,21.1%,unrespectively(χ^(2)=1.004,P=0.316).The 1-,3-and 5-year locoregional control rates were 85.5%,59.8%,27.8%and 63.6%,40.2%,16.4%,respectively(χ^(2)=7.307,P=0.007).Subgroup a-nalysis indicated that the subgroup with survival benefit from PORT were the patients with positive subprolongation lymph nodes(χ^(2)=4.146,P=0.024)and the group with multiple N_(2) metastases(χ^(2)=3.914,P=0.031).The subgroups with local control benefits from PORT were the patients with positive subprotuberance lymph nodes(^2=3.345,P=0.043),the group with multiple N_(2) metastases(χ^(2)=5.612,P=0.018),and the T_(3) staging group(χ^(2)=4.142,P=0.032).Conclusions Postoperative rad

关 键 词：非小细胞肺癌 药物疗法 放射疗法 预后 

分 类 号：R734.2[医药卫生—肿瘤]