【摘要】：目的 :探討競(jìng)爭(zhēng)風(fēng)險(xiǎn)場(chǎng)合下影響宮頸癌患者預(yù)后的因素。方法:選取美國(guó)醫(yī)療保險(xiǎn)監(jiān)測(cè)、流行病學(xué)和最終結(jié)果(Surveillance,Epidemiology and End Results,SEER)數(shù)據(jù)庫(kù)中1988—2008年華人宮頸癌患者的數(shù)據(jù)。興趣事件為患者死于宮頸癌,競(jìng)爭(zhēng)事件為死于其他疾病(如心臟病或其他腫瘤等)。在考慮競(jìng)爭(zhēng)風(fēng)險(xiǎn)時(shí),運(yùn)用累積風(fēng)險(xiǎn)模型計(jì)算不同診斷年齡、國(guó)際婦產(chǎn)科聯(lián)盟(International Federation of Gynecology and Obstetrics,FIGO)分期、淋巴結(jié)轉(zhuǎn)移程度及放療情況下興趣事件的累積發(fā)生率,組間比較采用Gray檢驗(yàn);然后,運(yùn)用Fine-Gray模型進(jìn)行多因素回歸分析。結(jié)果 :共有585例宮頸癌患者納入分析,其中50例患者發(fā)生興趣事件,43例患者發(fā)生競(jìng)爭(zhēng)事件。經(jīng)Gray檢驗(yàn)發(fā)現(xiàn),在不同初診年齡、FIGO分期、淋巴結(jié)轉(zhuǎn)移程度和放療情況下興趣事件的累積發(fā)生率差異均有統(tǒng)計(jì)學(xué)意義(P值均0.001);多因素回歸分析顯示,在Fine-Gray模型中,FIGO分期與淋巴結(jié)轉(zhuǎn)移程度是宮頸癌患者預(yù)后的獨(dú)立危險(xiǎn)因素(P值均0.05)。在競(jìng)爭(zhēng)風(fēng)險(xiǎn)存在時(shí),原位癌(0期)、Ⅱ期和Ⅲ期患者死于宮頸癌的相對(duì)危險(xiǎn)度是Ⅰ期患者的0.022倍、2.34倍和3.57倍,而區(qū)域(近端)淋巴結(jié)轉(zhuǎn)移和遠(yuǎn)端淋巴結(jié)轉(zhuǎn)移的患者與無(wú)淋巴轉(zhuǎn)移的患者相比死于宮頸癌的風(fēng)險(xiǎn)更高(相對(duì)危險(xiǎn)度分別為2.497和3.518)。結(jié)論 :競(jìng)爭(zhēng)風(fēng)險(xiǎn)模型下,宮頸癌患者的FIGO分期越高,淋巴轉(zhuǎn)移越嚴(yán)重,則預(yù)后越差。當(dāng)存在競(jìng)爭(zhēng)風(fēng)險(xiǎn)時(shí),應(yīng)合理運(yùn)用分析方法和模型來(lái)進(jìn)行數(shù)據(jù)分析。
[Abstract]:Objective: to investigate the prognostic factors of cervical cancer patients in competitive risk situations. Methods: the data of Chinese patients with cervical cancer from 1988 to 2008 were collected from the American Medical Insurance Surveillance, Epidemiology and final results (Surveillance,Epidemiology and End Results,SEER) database. Events of interest include death from cervical cancer and competition from other diseases (such as heart disease or other tumours). When considering the competitive risk, the cumulative risk model was used to calculate the cumulative incidence of events of interest under different diagnostic ages, (International Federation of Gynecology and Obstetrics,FIGO stages, lymph node metastasis and radiotherapy. Gray test was used to compare the two groups. Then, the Fine-Gray model is used for multivariate regression analysis. Results: a total of 585 patients with cervical cancer were included in the analysis, including 50 patients with interest events and 43 patients with competitive events. Gray test showed that there were significant differences in cumulative incidence of interest events in different age, FIGO stage, lymph node metastasis and radiotherapy (P all 0.001). Multivariate regression analysis showed that FIGO staging and lymph node metastasis were independent prognostic factors of cervical cancer in Fine-Gray model (P < 0. 05). The relative risk of dying from cervical cancer in situ (stage 0), stage 鈪，

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