倾向评分匹配选择后腹腔镜与开腹肝切除的临床比较
Clinical comparison of laparoscopic and open liver resection after propensity matching selection.
作者信息
Meguro Makoto, Mizuguchi Toru, Kawamoto Masaki, Ota Shigenori, Ishii Masayuki, Nishidate Toshihiko, Okita Kenji, Kimura Yasutoshi, Hirata Koichi
机构信息
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
出版信息
Surgery. 2015 Sep;158(3):573-87. doi: 10.1016/j.surg.2015.02.031. Epub 2015 Jun 25.
BACKGROUND
This study aimed to compare the radicality for and clinical advantages of laparoscopic liver resection, which is increasingly used, and the corresponding open procedure by propensity score matching analysis.
METHODS
We analyzed 260 hepatocellular carcinoma patients who underwent initial liver resection at our department between January 2003 and June 2011, including 60 laparoscopic (the Lap group) and 200 open cases (the Open group). Propensity scores were calculated for each patient via the use of various clinicopathologic features as covariates, and patients' survival was compared.
RESULTS
The Lap group had more women and patients of advanced age (n = 60) than the Open group (n = 200). Tumor size (2.3 cm vs 3.5 cm median), multiple tumors (18.3% vs 41.0%), vascular invasion (15.0% vs 36.5%), poor differentiation status (11.2% vs 24.5%), intraoperative bleeding (110 mL vs 420 mL; median), and operative time (277 minutes vs 312 minutes; median) were significantly more favorable in the Lap group than in the Open group because of a selection bias of the patients (Lap vs Open). The postoperative recurrence-free and overall survival rates were greater in the Lap group than in the Open group; however, when 35 patients from each group were analyzed after propensity score matching of clinicopathologic characteristics of the patients, intraoperative bleeding was lesser in the Lap group. The recurrence-free survival rates at 1, 3, and 5 years were 75.0%, 43.8%, and 43.8%, respectively, in the Lap group and 73.6%, 49.3%, and 37.2%, respectively, in the Open group, which indicated no significant differences (P = .954). Similarly, the overall survival rates at 1, 3, and 5 years were 93.9%, 82.1%, and 82.1%, respectively, in the Lap group and 94.3%, 85.2%, and 61.8%, respectively, in the Open group, indicating no significant differences between the 2 groups (P = .672).
CONCLUSION
Our results indicate that laparoscopic liver resection is comparable with the corresponding open procedure in clinical safety and prognostic efficacy.
背景
本研究旨在通过倾向评分匹配分析，比较日益常用的腹腔镜肝切除术及其相应的开放手术的根治性和临床优势。
方法
我们分析了2003年1月至2011年6月间在我科接受初次肝切除的260例肝细胞癌患者，其中60例为腹腔镜手术（腹腔镜组），200例为开放手术（开放组）。通过将各种临床病理特征作为协变量计算每位患者的倾向评分，并比较患者的生存率。
结果
腹腔镜组女性和高龄患者（n = 60）比开放组（n = 200）更多。由于患者选择偏倚（腹腔镜组与开放组），腹腔镜组的肿瘤大小（中位值2.3 cm对3.5 cm）、多发肿瘤（18.3%对41.0%）、血管侵犯（15.0%对36.5%）、低分化状态（11.2%对24.5%）、术中出血（中位值110 mL对420 mL）及手术时间（中位值277分钟对312分钟）均显著优于开放组。腹腔镜组术后无复发生存率和总生存率高于开放组；然而，在对患者临床病理特征进行倾向评分匹配后，每组分析35例患者时，腹腔镜组术中出血较少。腹腔镜组1年、3年和5年的无复发生存率分别为75.0%、43.8%和43.8%，开放组分别为73.6%、49.3%和37.2%，差异无统计学意义（P = 0.954）。同样，腹腔镜组1年、3年和5年的总生存率分别为93.9%、82.1%和82.1%，开放组分别为94.3%、85.2%和61.8%，两组间差异无统计学意义（P = 0.672）。
结论
我们的结果表明，腹腔镜肝切除术在临床安全性和预后疗效方面与相应的开放手术相当。
Zotero 插件