1130例非小細(xì)胞肺癌手術(shù)患者術(shù)前血清CEA水平預(yù)后價(jià)值的傾向性匹配研究
發(fā)布時間：2018-12-27 10:08
【摘要】：原發(fā)性肺癌是全球范圍內(nèi)發(fā)病率和病死率最高的癌癥,其中85%為非小細(xì)胞肺癌(NSCLC)。臨床對NSCLC患者遠(yuǎn)期生存風(fēng)險(xiǎn)的準(zhǔn)確評估,有利于正確選擇治療方案和制定隨診計(jì)劃。癌胚抗原(CEA)是NSCLC患者最常用的腫瘤標(biāo)記物,廣泛用于NSCLC的輔助診斷和療效監(jiān)測。研究表明,血清CEA水平對NSCLC患者遠(yuǎn)期預(yù)后有預(yù)測價(jià)值,但目前缺乏大樣本、設(shè)計(jì)良好的臨床研究為此提供高循證級別證據(jù)。目的通過臨床大樣本隊(duì)列研究,探討NSCLC患者術(shù)前血清CEA水平的遠(yuǎn)期預(yù)后價(jià)值,并應(yīng)用循證醫(yī)學(xué)方法,為研究結(jié)論提供高循證醫(yī)學(xué)級別的證據(jù)。方法本研究為回顧性隊(duì)列研究,連續(xù)納入2006年7月至2011年6月在大連醫(yī)科大學(xué)附屬第一醫(yī)院胸外科接受手術(shù)治療的NSCLC患者1130例,根據(jù)患者術(shù)前血清CEA水平分為兩組,探究術(shù)前血清CEA水平對遠(yuǎn)期預(yù)后的預(yù)測價(jià)值,并通過傾向性評分匹配(PSM)控制混雜變量組間差異,提升研究結(jié)論的可靠性,再通過累積Meta分析的方法將研究結(jié)果與既往發(fā)表的研究結(jié)果進(jìn)行合并,以提供最高循證級別的臨床證據(jù)。結(jié)果1130患者中位生存期為44(0-61)個月,總體生存率為47.1%;中位無病生存時間為35(0-61)個月,未復(fù)發(fā)率為46.3%。兩組患者總體生存時間(p=0.004)和無病生存時間(p=0.009)有統(tǒng)計(jì)學(xué)差異;傾向性評分匹配后,兩組患者逐漸混雜因素匹配良好,預(yù)后差值明顯減小,術(shù)前血清CEA水平仍能夠影響遠(yuǎn)期預(yù)后;COX模型單因素分析顯示高CEA患者遠(yuǎn)期死亡HR=1.595(95%CI1.329-1.863,p=0.004),復(fù)發(fā)風(fēng)險(xiǎn)HR=1.498(95%CI 1.271-1.881,p=0.004);COX模型多因素分析顯示,高CEA患者遠(yuǎn)期死亡HR=1.586(95%CI 1.398-1.812,p=0.016),復(fù)發(fā)風(fēng)險(xiǎn)HR=1.413(95%CI 1.22-1.734,p=0.022);累積Meta分析顯示本研究總體生存風(fēng)險(xiǎn)HR與既往研究總體HR合并后,總體生存和無病生存的累積HR均與前相仿,且具有統(tǒng)計(jì)學(xué)意義。結(jié)論(1)隊(duì)列研究表明:術(shù)前血清CEA水平可以作為總體生存期和無病生存期的獨(dú)立影響因素之一。(2)傾向性評分匹配提供的更高循證級別證據(jù)表明:對于無差別的NSCLC患者總體,術(shù)前血清CEA水平影響患者遠(yuǎn)期預(yù)后,CEA高的患者預(yù)后差。(3)累積Meta分析最高循證級別證據(jù)表明:術(shù)前血清CEA水平對術(shù)后總體生存風(fēng)險(xiǎn)和無病生存風(fēng)險(xiǎn)均有預(yù)測價(jià)值。
[Abstract]:Primary lung cancer is the highest morbidity and fatality rate in the world, 85% of which are non-small cell lung cancer (NSCLC). Accurate assessment of long-term survival risk in patients with NSCLC is beneficial to correct treatment and follow-up plan. Carcinoembryonic antigen (CEA) is the most commonly used tumor marker in patients with NSCLC. Studies have shown that serum CEA levels can predict the long-term prognosis of NSCLC patients, but there is a lack of large samples at present, and well-designed clinical studies provide high evidence-based evidence for this purpose. Objective to evaluate the long-term prognostic value of serum CEA levels in patients with NSCLC by a large clinical cohort study and to provide evidence of high Evidence-Based Medicine (EBM) grade for the conclusions of Evidence-Based Medicine (EBM). Methods A retrospective cohort study was conducted in 1130 NSCLC patients who received surgical treatment in thoracic surgery of the first affiliated Hospital of Dalian Medical University from July 2006 to June 2011. The patients were divided into two groups according to the preoperative serum CEA level. To explore the predictive value of preoperative serum CEA level for long-term prognosis, and to control the differences between confounding variables by matching (PSM) with tendentiousness score, so as to improve the reliability of the study conclusions. The results were combined with previously published results by cumulative Meta analysis to provide the highest level of evidence-based clinical evidence. Results the median survival time of 1130 patients was 44 (0-61) months, the overall survival rate was 47.1, the median disease-free survival time was 35 (0-61) months, and the non-recurrence rate was 46.3%. There were significant differences between the two groups in total survival time (p0. 004) and disease-free survival time (p0. 009). After the tendentiousness score matching, the two groups gradually mixed factors matched well, and the difference of prognosis was obviously reduced. The preoperative serum CEA level could still affect the long-term prognosis. Univariate analysis of COX model showed that HR=1.595 (95CI1.329-1.863p0.004) and HR=1.498 (95%CI 1.271-1.881p0.004) were long-term mortality in patients with high CEA. The multivariate analysis of COX model showed that HR=1.586 (95%CI 1.398-1.812) and HR=1.413 (95%CI 1.22-1.734) were long-term mortality (95%CI 1.398-1.812) and HR=1.413 (95%CI 1.731.734) in patients with high CEA. Cumulative Meta analysis showed that the cumulative HR of total survival and disease-free survival were similar to those of previous studies after the combination of HR and HR. Conclusion (1) the cohort study showed that preoperative serum CEA level could be one of the independent factors of overall survival and disease-free survival. There was no difference in the overall number of NSCLC patients, Preoperative serum CEA level affects the long-term prognosis of patients, and the prognosis of patients with high CEA is poor. (3) the cumulative Meta analysis of the highest evidence-based evidence shows that preoperative serum CEA level can predict the overall survival risk and disease-free survival risk.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
[Abstract]:Primary lung cancer is the highest morbidity and fatality rate in the world, 85% of which are non-small cell lung cancer (NSCLC). Accurate assessment of long-term survival risk in patients with NSCLC is beneficial to correct treatment and follow-up plan. Carcinoembryonic antigen (CEA) is the most commonly used tumor marker in patients with NSCLC. Studies have shown that serum CEA levels can predict the long-term prognosis of NSCLC patients, but there is a lack of large samples at present, and well-designed clinical studies provide high evidence-based evidence for this purpose. Objective to evaluate the long-term prognostic value of serum CEA levels in patients with NSCLC by a large clinical cohort study and to provide evidence of high Evidence-Based Medicine (EBM) grade for the conclusions of Evidence-Based Medicine (EBM). Methods A retrospective cohort study was conducted in 1130 NSCLC patients who received surgical treatment in thoracic surgery of the first affiliated Hospital of Dalian Medical University from July 2006 to June 2011. The patients were divided into two groups according to the preoperative serum CEA level. To explore the predictive value of preoperative serum CEA level for long-term prognosis, and to control the differences between confounding variables by matching (PSM) with tendentiousness score, so as to improve the reliability of the study conclusions. The results were combined with previously published results by cumulative Meta analysis to provide the highest level of evidence-based clinical evidence. Results the median survival time of 1130 patients was 44 (0-61) months, the overall survival rate was 47.1, the median disease-free survival time was 35 (0-61) months, and the non-recurrence rate was 46.3%. There were significant differences between the two groups in total survival time (p0. 004) and disease-free survival time (p0. 009). After the tendentiousness score matching, the two groups gradually mixed factors matched well, and the difference of prognosis was obviously reduced. The preoperative serum CEA level could still affect the long-term prognosis. Univariate analysis of COX model showed that HR=1.595 (95CI1.329-1.863p0.004) and HR=1.498 (95%CI 1.271-1.881p0.004) were long-term mortality in patients with high CEA. The multivariate analysis of COX model showed that HR=1.586 (95%CI 1.398-1.812) and HR=1.413 (95%CI 1.22-1.734) were long-term mortality (95%CI 1.398-1.812) and HR=1.413 (95%CI 1.731.734) in patients with high CEA. Cumulative Meta analysis showed that the cumulative HR of total survival and disease-free survival were similar to those of previous studies after the combination of HR and HR. Conclusion (1) the cohort study showed that preoperative serum CEA level could be one of the independent factors of overall survival and disease-free survival. There was no difference in the overall number of NSCLC patients, Preoperative serum CEA level affects the long-term prognosis of patients, and the prognosis of patients with high CEA is poor. (3) the cumulative Meta analysis of the highest evidence-based evidence shows that preoperative serum CEA level can predict the overall survival risk and disease-free survival risk.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R734.2
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