基于倾向评分匹配分析多学科诊疗对非小细胞肺癌患者预后的影响

Effect of Multi-disciplinary Treatment on Survival Outcomes of Non-Small Cell Lung Cancer Patients Based on Propensity Score Matching

目的:通过倾向评分匹配(propensity score matching,PSM)分析评估多学科诊疗(multi-disciplinary treatment,MDT)对非小细胞肺癌(non-small cell lung cancer,NSCLC)患者预后的影响。方法:收集2013年8月至2017年12月期间四川省肿瘤医院诊治的NSCLC患者资料,根据是否接受MDT分为MDT组和非MDT组两组,按照1∶4进行PSM后对入组患者进行生存分析。结果:PSM前,诊断时年龄、ECOG评分和TNM分期在两组患者中的差异有统计学意义(P<0.05)。PSM后,对两组患者进行Cox回归分析发现,诊断时年龄(HR=1.964,95%CI:1.549~2.491,P<0.001)、ECOG评分(HR=3.218,95%CI:2.107~4.915,P<0.001)、TNM分期(HR=4.786,95%CI:2.918~7.849,P<0.001)均是影响非MDT组患者总生存的显著因素;而仅有诊断时年龄(HR=3.262,95%CI:1.884~5.649,P<0.001)会显著影响MDT组患者的总生存。此外,诊断时年龄(HR=2.110,95%CI:1.702~2.616,P<0.001)、ECOG评分(HR=2.340,95%CI:1.571~3.484,P<0.001)、TNM分期(HR=4.025,95%CI:2.625~6.170,P<0.001)和MDT(HR=1.458,95%CI:1.088~1.953,P=0.011)均是影响所有患者总生存的显著因素。结果表明,MDT能显著改善NSCLC患者总生存情况(中位生存时间:48.0个月vs 38.0个月,P=0.037)。结论:MDT可能是一种重要的诊疗干预手段,有利于改善NSCLC患者的预后。

Objective:To evaluate the effect of multi-disciplinary treatment(MDT)on survival outcomes of non-small cell lung cancer(NSCLC)based on propensity score matching(PSM).Methods:From August 2013 to December 2017,data of NSCLC patients from Sichuan Cancer Hospital were collected and divided into two groups according to whether they received MDT.The survival was analyzed for enrolled patients after creating matched samples using 1∶4 matching on the propensity score.Results:Before PSM,there were significant differences in age at diagnosis,ECOG score and TNM stage between the two groups(P<0.05).After PSM,the Cox regression model revealed that age at diagnosis(HR:1.964,95%CI:1.549-2.491,P<0.001),ECOG score(HR:3.218,95%CI:2.107-4.915,P<0.001),TNM stage(HR:4.786,95%CI:2.918-7.849,P<0.001)were factors affecting overall survival(OS)for patients in the non-MDT group,while age at diagnosis(HR:3.262,95%CI:1.884-5.649,P<0.001)was the factor affecting OS for patients in the MDT group;moreover,age at diagnosis(HR:2.110,95%CI:1.702-2.616,P<0.001),ECOG score(HR:2.340,95%CI:1.571-3.484,P<0.001),TNM stage(HR:4.025,95%CI:2.625-6.170,P<0.001)and MDT(HR:1.458,95%CI:1.088-1.953,P=0.011)were factors affecting OS for all patients,indicating that MDT could improve the OS of NSCLC patients significantly(median survival time in the MDT group:48.0 months,that in the non-MDT group:38.0 months,P=0.037).Conclusion:MDT may be an important diagnosis and treatment intervention to improve the prognosis of NSCLC patients.