平衡组间协变量后射频消融术和经皮穿刺无水乙醇瘤内注射治疗原发性肝癌效果的比较

目的：探讨平衡组间协变量后评价射频消融术(RFA)和经皮无水乙醇注射（PEI）治疗早期原发性肝癌（HCC）患者的疗效，阐明平衡组间协变量的意义。方法：选择HCC患者342例，其中接受RFA者（RFA组）189例， 接受PEI者（PEI组）153例。采用倾向指数匹配卡钳法均衡组间的协变量，对匹配前后的数据进行生存分析，比较2组患者的生存率。结果：倾向指数匹配前，2组患者间协变量不均衡。COX回归分析，Child分级高、有肝癌家族史、HbsAg阳性、AFP水平升高、GT水平升高、肿瘤大和数量多是影响患者死亡率的危险因素（风险比>1，P<0.05）；但是RFA组和PEI组患者死亡率比较差异无统计学意义（P>0.05）。倾向指数匹配之后，2组患者间协变量均衡；RFA组和PEI组患者的1年生存率分别为81.37%和73.48%；2年生存率分别为46.64%和36.81%； 3年生存率分别为21.53%和14.5%；中位生存时间分别为1.80和1.40年。Logrank检验,RFA组患者的生存率高于PEI组(P<0.05)。结论：倾向指数匹配法平衡组间协变量后RFA治疗HCC效果优于PEI法，平衡组间协变量可对HCC患者的治疗效果做出正确评价。

Comparison of effects between radiofrequency ablation and percutaneous etharol injection in treatment of hepatocellular carcinoma after balancing covariates between groups

Objective To study the effects of radiofrequency ablation(RFA) and percutaneous ethanol injection(PEI)on early-stage hepatocellular carcinoma(HCC) patients and to clarify the significance of balancing covariates between groups.Methods 342 HCC patients were selected,in which 189 patients were treated with RFA(RFA group) and 153 patients were treated with PEI(PEI group).The covariates in two groups were balanced by propensity score caliper matching,and the survival rates of patients in two groups were analyzed.Results Before matching of propensity score,the covariates in two groups were imbalanced.The COX regression results showed that high Chlid-pugh,family history with HCC,positive HbsAg,high AFP and GT levels,bigger tumor size and multiple nodules were the dangerous factors which could affect the mortality rates of HCC patients(harzard ratio>1,P<0.05);but the difference of mortality rates between two groups was not statistically significant(P>0.05).After matching of propensity score,the covariates were balanced;the survival analysis result showed that the one-year survival rates of patients in RFA and PEI groups were 81.37% and 73.48%,respectively;the two-year survival rates were 46.64% and 36.81%,respectively;the three-year survival rates were 21.53% and 14.5%,respectively;and the median survival time were 1.80 and 1.40 year,respectively.The Logrank test results showed that the survival rates of patients in RFA group were higher than those in PEI group(P<0.05).Conclusion The effect of RFA in treatment of HCC is better than that of PEI after balancing covariates with propensity score,and balancing covariates between groups can evaluate the curative effect of HCC patients correctly.