双稳健半参模型法评价CAF和TAC化疗方案治疗乳腺癌疗效的回顾性分析

Retrospective Analysis on the Efficacy of CAF and TAC Chemotherapy in the Treatment of Breast Cancer with Double-robust Semiparametric Model Method

目的探索TAC化疗方案和CAF化疗方案治疗乳腺癌的真实疗效。方法采用回顾性队列研究的方法选择乳腺癌患者800例,探索不同的化疗方案对乳腺癌患者的生存率的影响。结果 PS匹配后经过log-rank检验两组生存曲线之间差别有统计学意义(P<0.05),得出TAC化疗方案治疗乳腺癌的效果优于CAF化疗方案。PS匹配前利用Cox回归模型和logistic回归模型,分别采用PS回归调整法、PS逆概率处理加权法(IPTW)、PS标化死亡比加权法(SMRW)和双稳健半参模型法(PS回归调整与加权法的结合,DRW)进行两种化疗方案的生存分析,加权之后基线协变量得到均衡,并经过调整的log-rank检验两组生存曲线之间差别均有统计学意义(P<0.05),且结果均显示TAC化疗方案治疗乳腺癌的效果优于CAF化疗方案。通过对不同模型之间的比较,利用DRIPTW模型和DRSMRW模型得出的处理效应的偏倚显著减小,且减小偏倚的效果优于与之相对的IPTW和SMRW法,同时也优于匹配法和回归调整法,其中DRSMRW模型法最优,相对偏倚为0.037。结论在回顾性队列研究中,TAC化疗方案治疗乳腺癌的效果优于CAF化疗方案,为乳腺癌患者指定了最佳的治疗方案。

Objective This study was aimed to explore the real efficacy of TAC and CAF chemotherapy in the treatment of breast cancer.Methods A retrospective cohort study was adopted to investigate 800 breast cancer patients,then explore the impact of different chemotherapy regimens on the survival rate of patients with breast cancer.Results The age,marital status and tumor nature of the two groups of breast cancer patients matched by PS matching were not balanced before matching,and after the matching,the survival curves of the two groups had significant difference after Log-rank test(P<0.05).Concluded that TAC chemotherapy regimen in the treatment of breast cancer better than the CAF chemotherapy.Before matching,Cox regression model and logistic regression model were used.And PS integrative regression adjustment,PS inverse probability weighting method(IPTW),PS standardized mortality weighting method(SMRW) were applied to the analysis on the two chemotherapy regimens.After adjusted Log-rank test between the two survival curves were statistically significant(P<0.05),and the results showed that TAC Chemotherapy regimen for breast cancer is superior to CAF regimen.By comparing the different models,the bias of the treatment effect obtained by the SMRW model and the DRSMRW model was significantly reduced,and the effect of reducing the bias was superior to the corresponding IPTW and SMRW methods and also better than the matching method and regression adjustment method.The DRSMRW model method was the best,the relative bias was 0.037.Conclusion In a retrospective cohort study,the effect of TAC chemotherapy regimen on breast cancerwas superior to that of CAF chemotherapy regimen.Designated the best treatment for breast cancer patients.