Thabut G, Fournier M
Service de pneumologie B et transplantation pulmonaire, université Paris-Diderot-Paris 7, 75018 Paris, France.
Rev Mal Respir. 2011 Jun;28(6):e1-6. doi: 10.1016/j.rmr.2011.04.007. Epub 2011 Jun 17.
Published studies used several methods to assess the impact of lung transplantation on patient survival. To interpret the results of these studies, a basic understanding of the models used and underlying hypotheses is required.
The most often used method consists in assessing the survival of waiting-list patients and measuring the impact of lung transplantation on the baseline hazard (instantaneous risk) for death, usually with a Cox proportional hazards model. This strategy involves strong assumptions about the link between the baseline hazard in waiting-list patients and lung transplant recipients. Whether these assumptions are true is extremely difficult to establish. Some studies compared predicted survival without transplantation to observed survival after transplantation. We recently reported a new method in which predicted survival without transplantation is compared to predicted survival after transplantation.
All the methods described to date evaluate only the impact of transplantation on patient survival. The concomitant use of other markers such as respiratory function or quality of life would produce a more detailed picture of lung transplantation benefits.
Evaluating the benefits of lung transplantation involves the use of complex statistical methods. The results should be considered with circumspection, and none of the methods described to date allows definitive conclusions.
已发表的研究采用了多种方法来评估肺移植对患者生存的影响。为了解释这些研究结果，需要对所使用的模型和潜在假设具备基本的理解。
最常用的方法是评估等待名单上患者的生存情况，并测量肺移植对死亡基线风险（即时风险）的影响，通常使用Cox比例风险模型。该策略涉及对等待名单上患者的基线风险与肺移植受者之间联系的强烈假设。这些假设是否成立极难确定。一些研究将未移植时的预测生存与移植后的观察生存进行了比较。我们最近报告了一种新方法，即将未移植时的预测生存与移植后的预测生存进行比较。
迄今为止描述的所有方法仅评估了移植对患者生存的影响。同时使用其他指标，如呼吸功能或生活质量，将更详细地呈现肺移植的益处。
评估肺移植的益处涉及使用复杂的统计方法。对结果应谨慎考虑，并且迄今为止描述的任何方法都无法得出确定性结论。
