机器人与腹腔镜胃癌根治术的长期对比：2084 例连续患者的倾向评分加权分析。
Long-term Comparison of Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Propensity Score-weighted Analysis of 2084 Consecutive Patients.
机构信息
Department of Surgery, Ajou University School of Medicine, Suwon, Korea.
Department of Transplantation and Vascular Surgery, Ajou University School of Medicine, Suwon, Korea.
出版信息
Ann Surg. 2021 Jul 1;274(1):128-137. doi: 10.1097/SLA.0000000000003845.
OBJECTIVE
To compare long-term outcomes between robotic and LG approaches using propensity score weighting based on a generalized boosted method to control for selection bias.
SUMMARY OF BACKGROUND DATA
Minimally invasive surgical approaches for GC are increasing, yet limited evidence exists for long-term outcomes of robotic gastrectomy (RG).
METHODS
Patients (n = 2084) with GC stages I-III who underwent LG or RG between 2009 and 2017 were analyzed. Generalized boosted method was used to estimate a propensity score derived from all available preoperative characteristics. Long-term outcomes were compared using the adjusted Kaplan-Meier method and the weighted Cox proportional hazards regression model.
RESULTS
After propensity score weighting, the population was balanced. Patients who underwent RG showed reduced blood loss (16 mL less, P = 0.025), sufficient lymph node harvest from the initial period, and no changes in surgical outcomes over time. With 52-month median follow-up, no difference was noted in 5-year overall survival in unweighted [91.5% in LG vs 94% in RG; hazard ratio (HR), 0.71; 95% confidence interval (CI), 0.46-1.1; P = 0.126] and weighted populations (94.2% in LG vs 93.2% in RG; HR, 0.88; 95% CI, 0.52-1.48; P = 0.636). There were no differences in 5-year recurrence-free survival (RFS), with unweighted 5-year RFS of 95.4% for LG and 95.2% for RG (HR, 0.95; 95% CI, 0.55-1.64; P = 0.845) and weighted 5-year RFS of 96.3% for LG and 95.3% for RG (HR, 1.24; 95% CI, 0.66-2.33; P = 0.498).
CONCLUSIONS
After balancing covariates, RG demonstrated reliable surgical outcomes from the beginning. Long-term survival after RG and LG for GC was similar.
目的
使用广义提升方法基于倾向评分加权比较机器人和 LG 方法的长期结果，以控制选择偏差。
背景数据摘要
用于 GC 的微创外科方法正在增加，但机器人胃切除术 (RG) 的长期结果证据有限。
方法
分析了 2009 年至 2017 年间接受 LG 或 RG 的 GC 分期 I-III 患者 (n = 2084)。使用广义提升方法从所有可用的术前特征中估计倾向评分。使用调整后的 Kaplan-Meier 方法和加权 Cox 比例风险回归模型比较长期结果。
结果
在进行倾向评分加权后，人群得到了平衡。接受 RG 的患者出血量减少（少 16 毫升，P = 0.025），初始时期淋巴结采集充足，并且手术结果随时间没有变化。中位随访 52 个月时，未加权人群中 5 年总生存率无差异[LG 为 91.5%，RG 为 94%；风险比 (HR)，0.71；95%置信区间 (CI)，0.46-1.1；P = 0.126]和加权人群（LG 为 94.2%，RG 为 93.2%；HR，0.88；95%CI，0.52-1.48；P = 0.636）。5 年无复发生存率（RFS）无差异，LG 的 5 年 RFS 为 95.4%，RG 为 95.2%（HR，0.95；95%CI，0.55-1.64；P = 0.845），LG 的 5 年 RFS 为 96.3%，加权后为 95.3%。RG（HR，1.24；95%CI，0.66-2.33；P = 0.498）。
结论
在平衡协变量后，RG 从一开始就表现出可靠的手术结果。GC 后 RG 和 LG 的长期生存相似。
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