Support Care Cancer. 1994 May;2(3):171-6.
In comparative trials on antiemetic efficacy of different regimens, the positive correlation between the probabilities of vomiting and of nausea could hide some confounding effect. Our work seeks to detect such effects. The data from two large studies on prevention of cisplatin-induced emesis were re-analyzed using two multifactorial logistic models. The first study compared ondansetron + dexamethasone (Ond+Dex) with metoclopramide+dexamethasone+diphenhydramine (Mtc+Dex+Dip), the second compared Mtc+Dex+Dip with Mtc+prednisolone. A group of 267 patients in the first study and 343 in the second, all evaluable for clinical efficacy, were followed for three subsequent cycles of chemotherapy. The antiemetic regimen administered and the complete protection from acute vomiting and nausea were recorded. In the first study (cycle 1), after adjustment for the presence/absence of vomiting, the two therapies were no longer found significantly different on complete protection from nausea: the greater efficacy of Ond+Dex in preventing nausea was due to a confounding effect. Instead, in the second study, the greater efficacy of Mtc/Dex/Dip in preventing both nausea and vomiting was confirmed. The results indicate that, when a correlation between two responses is detected, multifactorial analyses should be performed to identify the possible presence of some confounding effect. The proof that the presence/absence of vomiting is a confounding factor for the relationship between the different efficacy of the two antiemetic regimens for complete protection from nausea, highlighting the same efficacy of the two therapies in preventing nausea, supports the hypothesis of the existence of two kinds of nausea, one independent of vomiting, the other concomitant with it.
在不同方案止吐疗效的对比试验中，呕吐概率与恶心概率之间的正相关可能掩盖一些混杂效应。我们的研究旨在检测此类效应。利用两个多因素逻辑模型对两项关于预防顺铂所致呕吐的大型研究数据进行了重新分析。第一项研究比较了昂丹司琼+地塞米松（Ond+Dex）与甲氧氯普胺+地塞米松+苯海拉明（Mtc+Dex+Dip），第二项研究比较了Mtc+Dex+Dip与Mtc+泼尼松龙。第一项研究中的267例患者和第二项研究中的343例患者，所有患者均对临床疗效可进行评估，在随后的三个化疗周期中进行随访。记录所给予的止吐方案以及对急性呕吐和恶心的完全防护情况。在第一项研究（第1周期）中，在对呕吐的有无进行调整后，两种疗法在对恶心的完全防护方面不再有显著差异：Ond+Dex在预防恶心方面的更高疗效是由于混杂效应。相反，在第二项研究中，Mtc/Dex/Dip在预防恶心和呕吐方面的更高疗效得到了证实。结果表明，当检测到两种反应之间存在相关性时，应进行多因素分析以确定可能存在的一些混杂效应。呕吐的有无是两种止吐方案在对恶心的完全防护方面不同疗效之间关系的一个混杂因素，这一证据突出了两种疗法在预防恶心方面的相同疗效，支持了存在两种恶心的假说，一种与呕吐无关，另一种与呕吐相伴。
