- 學位論文
早期攝護腺癌病患接受根除性攝護腺切除手術與晚期攝護腺癌病患接受荷爾蒙治療後復發因子之探討
Analysis Risk Factors of Relapse in The Patients with Prostate Cancer Receiving Radical Prostatectomy and Prostate with Advanced Prostate Cancer Receiving Hormone Therapy
摘要
根據行政院衛生署的統計，攝護腺癌已經連續3年高居男性十大癌症發生率第5名，死亡率的第7名，如此重要公共衛生議題，需要更多研究以了解其病因，但在台灣卻顯少針對攝護腺癌治療後復發因子之探討。故本研究將以血清中攝護腺癌特異抗原作為復發的依據，來探討早晚期攝護腺癌病患，接受根除性切除手術及荷爾蒙治療其復發因子及無病存活期分析。 方法：本研究以回溯病歷資料的方法，找出從1990年5月至2010年3月，共402位在中部某醫學中心確診的攝護腺癌病例，治療方式分別為根除性攝護腺癌切除手術與荷爾蒙治療。年齡分布由42歲至74歲（平均70歲）。手術治療組共有191位病患；荷爾蒙治療組則有211位病患，體外放射線(Radiotherapy)者則不加入本研究。以SPSS 14.0統計軟體，利用存活分析來評估臨床因子與發生生化復發的關係。 結果：經由平均7.1年追蹤，在191位接受早期攝護腺癌切除術病患中有93位復發（54％），復發時間中位數為61.9個月；而211位攝護腺癌晚期以荷爾蒙治療的病患中，有147復發（87.5％），復發時間中位數為29個月；由Kaplan-Meier Analysis 和 Log-Rank Test中發現有2個變項在統計上有顯著性差異(P<0.05)，分別是「治療前前列腺特異抗原」及「格里森總分」與攝護腺癌的復發有顯著相關。 結論：攝護腺癌的高死亡率是因為大部分都是已經轉移的晚期病患，如果能早期診斷後給予積極的治療，其存活率和沒有得攝護腺癌病患一樣。在台灣因國情不同及健康認知不足，相較於晚期攝護腺癌病患較早期攝護腺癌病患復發時間較早，建議政府機關應推廣攝護腺癌篩檢，以期能早期發現早期治療。
並列摘要
The incidence rate of prostate cancer has been ranked the fifth among the males in Taiwan. In terms of cancer mortality, prostate cancer has climbed up the seventh. For such a important public health threat, many studies have been conducted to understand its etiology. However, few studies in Taiwan have focused on the recurrence of prostate cancer. In this study, we compare the factors associated with the recurrence of prostate cancer between patients who received hormone treatment and those who underwent a radical surgery. Using a retrospective method, we reviewed the medical records to identify prostate cancer patients who were treated and followed in a medical center located in central Taiwan between May 1990 and March 2010. A total of 402 prostate cancer cases (191 of them received a radical surgery and 211 patients receiving hormone treatment) were confirmed. Survival functions and Cox regressions were used to examine factors associated the recurrence of prostate cancer. Results showed that, among the 191 patients who received a radical surgery, 93 (54%) of them had a recurred prostate cancer, with a median time to recurrence of 61.9 months. For the case receiving hormone treatment, 147 cases had a recurrence, with a median time to recurrence of 29 months. From our Cox models, we found that the reading of Prostate Specific Antigen and Gleason score were significant predictors for a recurrence of prostate cancer in both the surgery and hormone-therapy groups. Our findings indicated that, in addition to the risk of having a higher mortality, later stage of prostate cancer patients are also more likely to have a recurrence. It suggests that the best preventive strategy for prostate cancer is to promote cancer screening for early detection.
參考文獻
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