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目的利用倾向指数法匹配混杂因素,对动脉化疗栓塞术(TACE)和动脉化疗栓塞术结合三维适形放射治疗术(TACE+3DCRT)2种治疗方式治疗原发性肝癌(HCC)的疗效和预后进行对比分析,探讨倾向指数法在平衡混杂因素中的应用。方法山东省肿瘤医院获得HCC患者681例,其中TACE组患者339例,TACE+3DCRT组患者342例;采用logistic回归模型计算HCC患者的倾向指数,然后按照倾向指数进行组间卡钳匹配,对匹配前后的数据进行生存分析。结果倾向指数法进行匹配后,年龄、Child-Pugh分级、有无门静脉癌栓、HBsAg阳性等协变量达到了均衡;TACE组和TACE+3DCRT组的1年生存率分别为65.4%、79.7%,2年生存率分别为47.4%、60.9%,3年生存率分别为28.7%、36.7%,中位生存期分别为1.672、2.681年;log-rank检验结果显示2组生存曲线间差异有统计学意义(P=0.006)。结论 TACE+3DCRT治疗方法对HCC的治疗效果优于单纯TACE治疗;倾向指数法能有效降低组间的混杂偏倚,从而对HCC治疗方式的预后疗效做出正确评价。
Objective To evaluate the effect and prognosis of hepatocellular carcinoma (HCC) treated by two methods of TACE and arterial chemoembolization combined with three-dimensional conformal radiotherapy (TACE + 3DCRT) by means of propensity index matching and confounding factors. Conducted a comparative analysis to explore the application of propensity index method in the balance of confounding factors. Methods 681 HCC patients were obtained from Tumor Hospital of Shandong Province, among which 339 were TACE patients and 342 patients were TACE + 3DCRT patients. Logistic regression model was used to calculate the tendency index of HCC patients, and then the inter-group calipers were matched according to propensity index. Data for survival analysis. The results of propensity index method match, the age, Child-Pugh grading, with or without portal vein tumor thrombus, HBsAg positive covariates reached an equilibrium; TACE group and TACE + 3DCRT group 1 year survival rates were 65.4%, 79.7% The 2-year survival rates were 47.4% and 60.9% respectively. The 3-year survival rates were 28.7% and 36.7%, respectively. The median survival time was 1.672 and 2.681 years respectively. The log-rank test showed that the difference between the two survival curves was statistically significant Significance (P = 0.006). Conclusions TACE + 3DCRT treatment is superior to TACE alone in treatment of HCC. Tendency index method can effectively reduce the misclassification bias between groups, and thus make a correct assessment of the prognosis of HCC treatment.