良性前列腺肥大症(BPH)患者手術治療後是否降低未來前列腺癌之發生率：回溯式世代研究

Is Transurethral Resection of Prostate (TURP) Lowering the Risk of Prostatic Cancer for Patients with Benign Prostatic Hyperplasia：A Retrospective Cohort Study

謝峽浪(Hsia-Lang Hsieh)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00235

摘要

目的：本研究之主要目的為：1、嘗試經由?i計學方法証實下列?揚z之研究假設是否正確，該假設是：「前列腺良性增生(benign prostatic hyperplasia，BPH)患者接受經尿道前列腺切除術(transurethral resection of prostate，TURP)手術後，能夠導致降低該良性疾病患者將來罹患惡性疾病－前列腺癌症( carcinoma of prostate，CaP)之風險」。2、比較前列腺良性增生患者分別採手術治療、口服藥物治療與口服藥物併手術治療關於降低該患者將來罹患前列腺癌症機率之研究為目的。
方法：利用1997年至2009年全民健康保險資料庫之百萬抽樣歸人檔(LHID 2005)為資料來源，對樣本資料進行回溯性縱貫世代(retrospective cohort study)研究探討。透過：住院費用檔(DD)、住院醫令檔(DO)、門診處方及治療明細檔(CD)與疾病診斷代碼、樣本基本資料(ID)進行?i計分析。前述三組資料據以互為對照組比較。為達到?i計學上之客觀與公正性，利用貪婪配對(greedy match)使治療組別間之樣本分佈合理化，使用存活分析(survival analysis)?i計方法追?W不同治療組別治療後長達十二年期間，樣本轉變成惡性前列腺癌之風險。用SAS軟體，對資料庫中龐大樣本進行?i計分析、研究。並以P值與95%信賴區間(confidence interval)檢測研究結果之可信度。
結果：單純手術治療組結果，(1).未配對：95%CI〔0.285,0.690〕,P<.01,hazard ratio=0.443。(2).配對後：95%CI〔0.287,0.695〕,P<.01,hazard ratio=0.446。手術合併藥物治療組結果，(1).未配對：95%CI〔0.358,0.826〕,P<.05,hazard ratio=0.544。(2).配
對後：95%CI〔0.361,0.832〕,P<.05,hazard ratio=0.548。
結論：研究結果顯示，前列腺肥大症患者採單純手術治療或採手術合併藥物治療，將來其發生罹患前列腺癌之風險均顯著小於採單純口服藥物治療之患者。
關鍵詞：前列腺良性增生症、前列腺癌症、經尿道前列腺切除術

關鍵字

前列腺良性增生症 ； 前列腺癌症 ； 經尿道前列腺切除術

並列摘要

Purpose: The main purpose of this study is to prove the hypothesis that transurethral resection of prostate (TURP) procedure, as compared to medications alone, can lower the risk of prostatic cancer for patients with benign prostatic hyperplasia (BPH).
Methods: We used the National Health Insurance Database’s one million random sample (LHID 2005) from 1997-2009 as our data source. With a retrospective longitudinal cohort study design, we identified the patients with BPH if they had ICD-9-CM (international classification of disease, 9th version, clinical modification) code of 600.xx, and then followed them up until Dec. 31, 2009 to determine if they had prostatic cancer. According to the aforementioned three groups as control group one another were settled. To achieve the statistical nature of objectivity and impartiality, the use of greedy matching between groups to rationalize the distribution of samples, using survival analysis statistical methods for tracking different outcomes during the periods after their initial therapy. SAS software were used for analysing the large scale samples of database. The P- value with its related confidence interval were used for detecting the credibility of the final results.
Results: The hazard ratio (HR) of developing prostatic cancer for BPH patients undergone TURP alone is 0.443 (95%CI: 0.285-0.690,P<.01) compared to BPH patients received medication alone; After PS matching, the HR slightly increase to 0.446 (95%CI: 0.287-0.695, p<.01). For BPH patients undergone TURP combined with medication, the HR is 0.544 (95%CI: 0.358-0.826,P<.05); After PS matching, the HR slightly increase to 0.548 (95%CI: 0.361-0.832, p<.05).
Conclusion: Patients with BPH received operative procedure for treatment will decrease the risks of developing prostatic cancer in their future life.

並列關鍵字

benign prostatic hyperplasia ； prostatic cancer ； transurethral resection of prostate

參考文獻

于大雄、張聖原、馬正平. 中華民國台灣泌尿道惡性腫瘤死亡率之變遷.中華泌尿醫誌. 1990;1:168-74.

劉介宇、洪永泰、莊義利等. 台灣地區鄉鎮市區發展類型硬院於大型健康調查抽樣設計之研究. 健康管理學刊. 2006;4;1:22.

張淑梅. 台灣南部地區前列腺癌相關危險因子之研究. 高雄醫學大學公共衛生學研究所學位論文. 2002.

何小鳳、許光陽. 良性前列腺肥大病患之藥物經濟學研究. 臺北醫學大學藥學研究所學位論文. 2007.

林思嘉、闕士傑、顧記華. 探討α1-交感神經受體阻斷劑在人類前列腺癌細胞的抗癌作用機轉－體內及體外試驗。國立台灣大學醫學研究所碩士論文. 2009.