纵横结肠腺癌预后因素评估的新发现:竞争风险和COX回归分析之间的比较研究
Hongbo Su1, Shuping Xie2, Shanshan Wang3
1Department of General Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
Frontiers in medicine
|February 15, 2024
概括
竞争性风险分析准确地确定了横向结肠癌的预后因素,揭示了较大的手术和外部束辐射疗法可能无法改善生存率. 这凸显了针对横肠腺癌 (ATC) 量身定制的治疗计划的需要.
科学领域:
- 在瘤学瘤学.
- 生物统计学 生物统计学
- 流行病学 流行病学
背景情况:
- 纵横结肠腺癌 (ATC) 的预后是复杂的.
- 传统的统计方法可能会过分简化预后因素.
- 对癌症特定死亡的准确评估对于患者的治疗结果至关重要.
研究的目的:
- 将竞争性风险分析与传统的考克斯回归进行比较,用于ATC的预后因素评估.
- 确定ATC中癌症特异性死亡率的真正独立预后因素.
- 评估手术范围和放射治疗对ATC存活率的影响.
主要方法:
- 利用来自监测,流行病学和最终结果数据库的21,477名被诊断患有ATC的患者 (2000-2019) 的数据.
- 在多变量分析中使用分发危险函数 (SD) 和传统的考克斯回归来进行竞争性风险分析.
- 使用格雷测试计算了原始死亡率,并比较了使用格雷测试的差异.
主要成果:
- 在SD模型中,年龄被认为是显著的独立预后因素.
- 考克斯回归给出了性别和癌胚抗原的假阳性,并低估了与阶段相关的风险.
- 更大的手术范围和外部质子束放射治疗与风险增加有关,而不是改善生存率.
结论:
- 竞争风险分析为ATC特定死亡的预后因素提供了比Cox回归更准确的评估.
- 更广泛的外科干预和外部光束放射治疗可能不会提高ATC患者的长期存活率.
- 与其他结直肠癌相比,这些发现需要不同的治疗策略和ATC的预后评估.
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