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目的:应用倾向指数匹配法均衡组间协变量,评价手术切除合并辅助化疗对治疗局限期小细胞肺癌的疗效。方法:回顾性分析了本院2009年至2014年间诊断为局限期小细胞肺癌的157例住院患者临床资料,其中61例接受手术切除合并辅助化疗,96例接受单纯化疗或放化疗联合治疗。利用倾向指数评分方法,匹配卡钳值0.20,以治疗方式为因变量,以T分期,N分期,病灶数量和病理分型为协变量,均衡不平衡的协变量,模拟出随机化效果,分别对匹配前后的数据进行生存分析。结果:匹配前,手术组和非手术组的中位生存期分别为27个月(95%CI:2.73~51.26)和14个月(95%CI:11.8~16.18)。匹配后,所有协变量分布均达到均衡,比较匹配后两组患者的生存状况,手术组患者的中位生存期为27个月,非手术组中位生存期为17个月(95%CI:13.68~20.32)。Log-rank检验两组生存率具有统计学差异,P=0.001。结论:对于局限期小细胞肺癌患者,如果达到手术切除的临床指证,手术切除合并辅助化疗能使患者的生存获益;在治疗前如能准确诊断为小细胞肺癌的患者,临床分期能指导选择合适的治疗策略。
OBJECTIVE: To evaluate the efficacy of surgical resection combined with adjuvant chemotherapy in the treatment of small-cell lung cancer (SCLC) by using the propensity index matching method to balance the inter-group covariates. Methods: A retrospective analysis of clinical data of 157 hospitalized patients diagnosed with localized small cell lung cancer from 2009 to 2014 in our hospital was performed. Among them, 61 cases received surgical resection combined with adjuvant chemotherapy and 96 cases received simple chemotherapy or radiotherapy and chemotherapy. The propensity index score method was used to match the caliper value of 0.20. The treatment method was taken as the dependent variable, and the T stage, N stage, lesion number and pathological type were used as covariates to balance the unbalanced covariates and simulate the randomization effect. Before and after matching the data for survival analysis. RESULTS: Before matching, the median survival was 27 months (95% CI: 2.73 to 51.26) and 14 months (95% CI: 11.8 to 16.18) for the surgical and non-surgical groups, respectively. After matching, all the covariates were well-balanced. After two matched groups, the median survival time was 27 months in the operation group and 17 months in the non-operation group (95% CI: 13.68 ~ 20.32). There was a statistically significant difference in survival between the two groups by Log-rank test, P = 0.001. Conclusions: Surgical resection combined with adjuvant chemotherapy can benefit the survival of patients with locally advanced small cell lung cancer, if the clinical indication of surgical resection is achieved. If the patients with small cell lung cancer can be correctly diagnosed before treatment, the clinical stage can guide the choice The appropriate treatment strategy.