目的:应用倾向指数匹配法均衡组间的协变量,评价单纯应用放疗( CRT )与三维适形放疗联合化疗( CCRT)对局限期小细胞肺癌( LD-SCLC)的治疗效果。方法:LD-SCLC患者224例,其中CRT 109例,CCRT 115例。基线资料包括性别(1=男,0=女)、年龄、吸烟(1=是,2=否)、结核(1=有,2=无)、家族史(1=有,2=无)、TNM分期(1=Ⅰ期,2=Ⅱ期,3=ⅢA期,4=ⅢB期)、血清神经元特异性烯醇化酶(NSE)水平、KPS评分、肿瘤数量(1=单个,2=多个)等。以分组变量为因变量,以协变量为自变量,建立logistic回归模型,计算倾向指数,然后按照倾向指数进行组间卡钳匹配。分别对匹配前后的数据进行生存分析。结果:匹配前CRT组和CCRT组的中位生存期(95%置信区间)分别为2.15(1.96~2.48)和2.37(2.06~2.72) a,1 a生存率分别为82.65%和83.36%,2 a生存率分别为59.02%和64.30%,3 a生存率分别为25.28%和29.34%,两组生存曲线差异无统计学差异(χ2=2.173, P=0.186)。两组共94对匹配成功。匹配后CRT组和CCRT组的中位生存期(95%置信区间)分别为2.14(1.75~2.44)和2.75(2.38~2.92) a,1 a生存率分别为82.24%和85.36%,2 a生存率分别为56.39%和66.20%,3 a生存率分别为23.44%和34.37%,两组生存曲线差异有统计学意义(χ2=11.045,P=0.008)。结论:采用倾向指数匹配法能有效降低非随机化临床试验数据的混杂偏倚。
Aim: To compare the effects of single chemotherapy ( CRT ) and conformal radiotherapy combined with chemotherapy(CCRT) on limited disease small cell lung cancer (LD-SCLC) patients after balancing the covariates by pro-pensity score .Methods:A total of 224 LD-SCLC patients were subjected ,among which ,109 accepted CRT , and 115 ac-cepted CCRT .A logistic regression model was established ,and the treatment assignment was taken as the dependent varia-ble and the covariates as the independent variables .For each LD-SCLC patient , the propensity score was calculated for cal-iper matching and a survival analysis of the matched data was carried out .Results: Before matching , the median survival time (95%CI) of CRT and CCRT were 2.15(1.96-2.48) and 2.37(2.06-2.72) years,respectively;one-, two-, and three-year survival rates were 82.65%and 83.36%, 59.02% and 64.30%,25.28% and 29.34%, respectively.There was no significant difference in survival curve between the two groups (χ2 =2.173,P=0.186).A total of 94 pairs patients were matched by propensity score .After matching, the median survival time(95%CI) of CRT and CCRT were 2.14(1.75-2.44) and 2.75(2.38-2.92) years;One-, two-, and three-year survival rates were 82.24%and 85.36%, 56.39%and 66.20%, 23.44%and 34.37%, respectively.There was a significant difference in survival curve between the two groups (χ2 =11.045,P=0.008).Conclusion: Propensity score matching can effectively reduce the confounding bias of non-randomized clinical observational data .