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目的通过倾向指数平衡混杂因素,评价手术切除(SR)和经导管肝动脉化疗栓塞(TACE)两种方法治疗早期原发性肝癌(HCC)患者的疗效。方法收集2003至2011年间在山东省肿瘤医院接受SR或TACE治疗的早期HCC患者350例,其中接受SR患者192例,接受TACE患者158例。采用倾向指数卡钳匹配法均衡组间的协变量,对匹配后的数据进行生存分析,比较两组的生存率。结果倾向指数匹配前,两组间协变量不均衡,SR组的1年、2年、3年、4年生存率分别为80.92%、49.44%、33.73%、19.72%,中位生存期为2.00年;TACE组的1年、2年、3年、4年生存率分别为80.02%、53.92%、31.21%、13.42%,中位生存期为2.40年;log-rank检验结果表明SR与TACE两组生存曲线差异无统计学意义(P=0.710 8)。倾向指数匹配之后,两组间协变量均衡;SR组的1年、2年、3年、4年生存率分别为84.22%、57.68%、36.80%、24.09%,中位生存期为2.50年;TACE组的1年、2年、3年、4年生存率分别为73.84%、47.26%、28.31%、10.69%,中位生存期为2.00年;log-rank检验结果表明两组间生存曲线的差异有统计学意义(P=0.018 2),SR组的生存率高于TACE组。结论采用倾向指数匹配法降低混杂偏倚后,SR对早期HCC患者的治疗效果优于TACE。
Objective To evaluate the efficacy of surgical resection (SR) and transcatheter hepatic arterial chemoembolization (TACE) in the treatment of patients with early-stage primary hepatocellular carcinoma (HCC) by means of propensity index equilibrium confounders. Methods A total of 350 early HCC patients receiving SR or TACE in Shandong Cancer Hospital from 2003 to 2011 were collected, of which 192 received SR and 158 received TACE. The propensity index calipers matching method was used to equalize the covariates among groups. The matched data were analyzed for survival and the survival rates were compared between the two groups. Before the exponential matching, the covariates were not balanced. The 1-year, 2-year, 3-year and 4-year survival rates of SR group were 80.92%, 49.44%, 33.73% and 19.72% respectively, and the median survival time was 2.00 Year; the survival rates at 1 year, 2 years, 3 years and 4 years in TACE group were 80.02%, 53.92%, 31.21% and 13.42% respectively, and the median survival time was 2.40 years. The log-rank test showed that SR and TACE There was no significant difference in survival curves between the two groups (P = 0.710 8). After exponential matching, the covariates were balanced between the two groups. The 1-year, 2-year, 3-year and 4-year survival rates of SR group were 84.22%, 57.68%, 36.80% and 24.09% respectively. The median survival time was 2.5 years. The 1-year, 2-year, 3-year and 4-year survival rates in TACE group were 73.84%, 47.26%, 28.31% and 10.69%, respectively. The median survival time was 2.00 years. The log-rank test showed that the survival curves The difference was statistically significant (P = 0.018 2). The survival rate of SR group was higher than that of TACE group. CONCLUSIONS: The use of propensity index matching to reduce promiscuous misconduct results in the superior treatment of SR to early HCC patients over TACE.