基于倾向性评分逆概率加权法的脉络膜黑色素瘤患者疗效评价研究  

Efficacy evaluation of choroidal melanoma based on propensity score inverse probability of treatment weighting method

作　　者：石丽娟 李丽 石福艳[3] 周希彬[2] 吴志鸿[2] SHI Lijuan;LI Li;SHI Fuyan;ZHOU Xibin;WU Zhihong(Department of Ophthalmology,School of Clinical Medicine,Weifang Medical University,Weifang 261053,Shandong Province,China;Senior Department of Ophthalmology,the Third Medical Center of PLA General Hospital,Beijing 100039,China;Department of Health Statistics,School of Public Health,Weifang Medical University,Weifang 261053,Shandong Province,China)

机构地区：[1]潍坊医学院临床医学院眼科学教研室,山东省潍坊市261053 [2]解放军总医院第三医学中心眼科医学部,北京市100039 [3]潍坊医学院公共卫生学院卫生统计学教研室,山东省潍坊市261053

出　　处：《眼科新进展》2023年第4期308-312,317,共6页Recent Advances in Ophthalmology

基　　金：北航-首医大数据精准医疗高精尖创新中心同仁分中心开放基金项目(编号:BHTR-KFJJ-202017)。

摘　　要：目的 在平衡组间基线变量后,评价放射治疗与手术联合放射治疗两种治疗方式对脉络膜黑色素瘤患者的疗效,分析脉络膜黑色素瘤患者的预后影响因素,为脉络膜黑色素瘤的有效诊疗提供参考依据。方法 对2000年1月至2019年12月在SEER数据库中登记的脉络膜黑色素瘤患者进行分析,采用倾向性评分逆概率加权法(IPTW)对放射治疗和手术联合放射治疗两组患者的基线特征进行平衡。结果 本研究共筛选脉络膜黑色素瘤患者5547例,其中接受放射治疗者4422例、接受手术联合放射治疗治疗者1125例。在接受放射治疗的4422例患者中,光束辐射(BR)组1155例,放射性植入物(RI)组2608例,放射性同位素(RIT)组659例。Log-rank检验结果显示,逆概率加权前后,放射治疗组患者的预后均高于手术联合放射治疗组(P<0.000 1)。多因素Cox回归分析结果显示,在控制了种族、性别、多灶性、是否为首要恶性肿瘤、婚姻状态、从诊断到治疗的时间、年龄、眼别、诊断确认、放射治疗方法等混杂因素后,与放射治疗组患者相比,手术放射治疗组患者的特异性死亡风险为HR=4.385(95%CI=3.542~5.428)。与年龄<50岁组患者相比,50~<60岁组、60~<70岁组、70~<80岁组、≥80岁组患者的特异性死亡风险分别为HR=3.083(95%CI=0.825~4.238)、HR=4.045(95%CI=2.955~5.532)、HR=4.512(95%CI=3.115~6.529)、HR=6.877(95%CI=4.151~11.398);与恶性肿瘤数为1个组患者相比,肿瘤数为2个组和>2个组患者的特异性死亡风险分别为HR=0.698(95%CI=0.449~2.944)、HR=0.538(95%CI=0.317~0.913);从诊断到治疗的时间超过1个月的患者的风险比为2.732~4.154。Log-rank检验结果表明,IPTW前后BR、RI和RIT三组脉络膜黑色素瘤患者生存曲线间差异无统计学意义(P>0.05)。结论 放射治疗的长期疗效优于手术与放射治疗联合治疗;年龄、单病灶、诊断到治疗的时间和治疗方式可增加脉络膜黑色素瘤患者死亡的风险Objective To evaluate the efficacy of radiotherapy and surgery combined with radiotherapy on choroidal melanoma and analyze the prognostic factors of choroidal melanoma upon balancing the inter-group baseline variables,giving a reference for effective diagnosis and treatment of choroidal melanoma.Methods Patients with choroidal melanoma enrolled from the Surveillance,Epidemiology,and End Results database from January 2000 to December 2019 were analy zed.Propensity score inverse probability of treatment weighting(IPTW)was used to balance the baseline characteristics of patients in the radiotherapy group and combined surgery and radiotherapy group.Results A total of 5547 patientswith choroidal melanoma were selected in this study,including 4422 patients who received radiotherapy and 1125 patients who received surgery combined with radiotherapy.Among the 4422 patients who received radiotherapy,1155 were divided into the radioactive beam irradiation(BR)sub-group,2608 were divided into the radioactive implant(RI)sub-group,and 659 were divided into the radioactive isotope(RIT)sub-group.The log-rank test showed that before and after IPTW,the prognosis of patients in the radiotherapy group was higher than that in the combined surgery and radiotherapy group(both P<0.0001).The multivariate Cox regression analysis showed that after controlling the confounding factors such as race,gender,multifocality,primary malignant tumor,marital status,time from diagnosis to treatment,age,eye side,diagnosis confirmation and radiotherapy method,compared to patients in the radiotherapy group,the specific mortality risk in the combined surgery and radiotherapy group was HR=4.385(95%CI=3.542-5.428).Compared to patients under 50 years old,the specific mortality risk of patients aged 50-59 years,60-69 years,70-79 years and≥80 years was HR=3.083(95%CI=0.825-4.238),HR=4.045(95%CI=2.955-5.532),HR=4.512(95%CI=3.115-6.529),and HR=6.877(95%CI=4.151-11.398),respectively.Compared to patients with only 1 malignant tumor,the specific mortality risk of

关 键 词：脉络膜黑色素瘤 逆概率加权 疗效 生存分析 

分 类 号：R773.4[医药卫生—眼科]