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目的评价射频消融(RFA)治疗和射频消融联合无水酒精注射(RFA+PEI)治疗2种方式对原发性肝癌的治疗效果。方法采用Cox回归模型筛选影响肝癌患者生存时间的影响因素,利用logistic回归模型计算肝癌患者的倾向指数并按照倾向指数进行组间卡钳匹配,对匹配后的数据进行生存分析。结果 Cox逐步回归分析结果表明,肝癌患者生存时间的影响因素有Child分级、HBsAg携带情况、年龄、肿瘤疾病史、甲胎蛋白含量和治疗方式;匹配前,肝癌患者的年龄、Child分级、肿瘤疾病史、HBsAg携带情况及甲胎蛋白含量等因素在2组患者中分布不均衡,RFA组和RFA+PEI组的中位生存期分别为0.896和0.924年,1年生存率分别为43.9%和47.8%,2组患者的生存曲线差异无统计学意义(P>0.05);经卡钳匹配后,共有140对患者匹配成功,匹配率为52.7%,RFA组和RFA+PEI组的中位生存期分别为0.690和0.898年,1年生存率分别为32.7%和47.7%,2组患者生存曲线间差异有统计学意义(χ2=11.148,P=0.001)。结论 RFA+PEI治疗方式对肝癌的治疗效果优于RFA治疗;在肝癌的治疗效果评价中,组间卡钳匹配法可有效控制混杂因素。
Objective To evaluate the therapeutic effect of two kinds of radiofrequency ablation (RFA) and radiofrequency ablation combined with anhydrous alcohol injection (RFA + PEI) on primary liver cancer. Methods Cox regression model was used to screen the influencing factors of survival time of patients with liver cancer. Logistic regression model was used to calculate the tendency index of patients with liver cancer and the inter-group calipers were matched according to the propensity index. Survival analysis was performed on the matched data. Results The Cox stepwise regression analysis showed that the factors influencing the survival time of patients with HCC were Child classification, HBsAg carrier, age, tumor history, alpha-fetoprotein content and treatment methods. Before matching, the age, Child classification, History, HBsAg-carrying status and alpha-fetoprotein content and other factors in the two groups of patients with uneven distribution, RFA group and RFA + PEI group median survival was 0.896 and 0. 924, 1-year survival rates were 43.9% and 47.8 %. There was no significant difference in survival curves between the two groups (P> 0.05). After the matching by calipers, a total of 140 patients matched successfully, with a matching rate of 52.7%. The median survival time of RFA group and RFA + PEI group were 0.690 and 0.988, the 1-year survival rates were 32.7% and 47.7%, respectively, with significant difference between the two groups (χ2 = 11.148, P = 0.001). Conclusion RFA + PEI treatment is better than RFA in the treatment of liver cancer. In the evaluation of the therapeutic effect of liver cancer, the intercluster calipers matching method can effectively control the confounding factors.