手术对Ⅰ期鼻咽癌患者预后的影响:一个倾向性评分匹配分析

Effect of surgery on the prognosis of patients with stage Ⅰ nasopharyngeal carcinoma:A propensity score matching analysis

目的:因手术在Ⅰ期鼻咽癌患者初始治疗中的作用尚不明确,本研究旨在评估手术对Ⅰ期鼻咽癌患者生存的影响。方法:从美国SEER数据库内收集自2004—2015年诊断的Ⅰ期鼻咽癌患者。为确保基线特征的平衡,本研究应用了1:1倾向性评分匹配(propensity score matching,PSM)以平衡混杂因素的干扰。此外,我们采用卡方检验对患者的基线特征进行比较,采用Kaplan-Meier (K-M)生存分析以对比各亚组鼻咽癌患者的总生存率(overall survival,OS)和肿瘤特异性生存(cancer-specific survival,CSS)。最后,我们还建立了单因素和多因素Cox回归分析模型以确定影响生存的独立预后因素。结果:进行PSM后,共纳入258例患者,其中129名接受了手术。K-M生存分析显示:在全部I期鼻咽癌患者中,手术患者比未手术患者显示出了更优的5年OS(78.8%vs 62.7%,P=0.009)。在亚组分析中,单纯手术、单纯放疗和手术加放疗组均显示了相似的5年OS(68.1%、69.1%、82.9%,P=0.318)和CSS(84.9%、88.5%、92.8%,P=0.358)。在多因素Cox回归分析中,手术(HR=0.450,95%CI:0.284~0.714,P=0.001)为OS的保护性因素。年龄、分级、组织学类型、放疗及原发肿瘤数目等都是Ⅰ期鼻咽癌患者的独立预后因素。结论:手术对Ⅰ期鼻咽癌患者生存有积极影响。手术可能成为I期鼻咽癌患者初始治疗的另一选择。

Objective:To evaluate the effect of surgery on survival in patients with stage Ⅰ nasopharyngeal carcinoma(NPC),since the role of surgery in the initial treatment of patients with stage Ⅰ NPC.Methods:Patients with stage Ⅰ NPC diagnosed from 2004 to 2015 were collected from the Surveillance,Epidemiology,and End Results(SEER)database.The 1:1 propensity score matching(PSM) method was performed to ensure the balance of baseline characteristics and minimize the confounding in this study.Chi-square test was also used to compare baseline characteristics of the patients.Kaplan-Meier method and log-rank test were used to compare the overall survival(OS) and carcinoma-specific survival(CSS) among the subgroups.Univariate and multivariate Cox proportional hazard regression were applied to determine independent prognostic factors.Results:After 1:1 PSM,a total of258 patients were included,129 of whom underwent surgery.Kaplan-Meier analysis showed that in all patients with stage Ⅰ NPC, surgical patients showed significantly superior 5-year OS than non-surgical patients(78.8% vs62.7%,P=0.009).And,in the subgroups analysis,the surgery alone group,radiotherapy alone group and surgery plus radiotherapy group showed similar 5-year OS(68.1%,69.1%,82.9%,P=0.318) and CSS(84.9%,88.5%,92.8%,P=0.358).In multivariate Cox regression analysis,we identified that surgery(HR=0.450,95%CI:0.284 to 0.714,P=0.001) was significantly associated with better OS.And,age,grade,histology,radiotherapy,and the number of primary tumors were also independent prognostic factors for stage Ⅰ NPC.Conclusion:The present study highlights the positive effect of surgery on the survival of patients with stage Ⅰ NPC.It indicates that surgery may become a potential initial treatment option for patients with stage Ⅰ NPC.