Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA.
Epilepsia Open. 2022 Jun;7(2):344-349. doi: 10.1002/epi4.12585. Epub 2022 Feb 23.
Studies of epilepsy surgery outcomes are often small and thus underpowered to reach statistically valid conclusions. We hypothesized that ordinal logistic regression would have greater statistical power than binary logistic regression when analyzing epilepsy surgery outcomes. We reviewed 10 manuscripts included in a recent meta-analysis which found that mesial temporal sclerosis (MTS) predicted better surgical outcomes after a stereotactic laser amygdalohippocampectomy (SLAH). We extracted data from 239 patients from eight studies that reported four discrete Engel surgical outcomes after SLAH, stratified by the presence or absence of MTS. The rate of freedom from disabling seizures (Engel I) was 64.3% (110/171) for patients with MTS compared to 44.1% (30/68) without MTS. The statistical power to detect MTS as a predictor for better surgical outcome after a SLAH was 29% using ordinal regression, which was significantly more than the 13% power using binary logistic regression (paired t-test, P < .001). Only 120 patients are needed for this example to achieve 80% power to detect MTS as a predictor using ordinal regression, compared to 210 patients that are needed to achieve 80% power using binary logistic regression. Ordinal regression should be considered when analyzing ordinal outcomes (such as Engel surgical outcomes), especially for datasets with small sample sizes.
对癫痫手术结果的研究通常规模较小，因此在统计学上无法得出有效的结论。我们假设，在分析癫痫手术结果时，有序逻辑回归比二元逻辑回归具有更大的统计能力。我们回顾了最近一项荟萃分析中包含的 10 篇论文，这些论文发现内侧颞叶硬化症 (MTS) 预测立体定向激光杏仁核海马切除术 (SLAH) 后的手术结果更好。我们从 8 项研究中提取了 239 名患者的数据，这些研究报告了 SLAH 后 4 种离散的 Engel 手术结果，分为存在或不存在 MTS 两种情况。MTS 患者无致残性癫痫发作（Engel I）的比例为 64.3%（110/171），而无 MTS 患者的比例为 44.1%（30/68）。使用有序回归检测 MTS 作为 SLAH 后手术结果更好的预测因子的统计能力为 29%，这明显高于使用二元逻辑回归的 13%（配对 t 检验，P<.001）。对于这个例子，只需 120 名患者即可使用有序回归达到 80%的检测 MTS 作为预测因子的能力，而使用二元逻辑回归则需要 210 名患者。在分析有序结果（如 Engel 手术结果）时，应考虑使用有序回归，尤其是对于样本量较小的数据集。
