探討胰臟癌病患之臨床療效與醫療資源耗用分析

研究背景與目的胰臟癌是現今人類癌症中，死亡率極高且預後較差的惡性腫瘤之一。在西方國家胰臟癌位居癌症死因第四位，約佔總癌症死亡人數的6%，且近年來發生率有上升趨勢。在台灣，根據行政院衛生署2012年國人死因統計，胰臟癌已由排名第九名進升為第八名。且胰臟癌多好發於50歲後發生率呈線性上升，五年存活率約20%，死亡率高達95%。本研究目的在探討胰臟癌病患之趨勢分析、造成醫療資源耗用之主要因素及影響胰臟癌病患死亡率之重要因子。研究方法本文採回溯性研究，利用胰臟癌病患住院資料進行分析。研究對象為2008年1月至2013年12月診斷為胰臟癌個案，共計248人。使用SPSS 20.0 統計軟體，以T-test、卡方檢定、單因子變異數分析、複迴歸分析、Kaplan-Meier存活分析及Cox Analysis 進行住院天數、死亡風險及存活等分析。研究結果 248位研究對象中，男性有147位、女性有101位，平均年齡為64.4歲。近年來胰臟癌病患在住院醫療費用及化療費用有顯著上升，表示胰臟癌患者接受化療及住院相關治療比例有增加現象。研究結果發現影響住院天數因素有年齡、腫瘤位置、手術類型及治療模式。存活分析方面，胰臟癌病患整體平均存活期為12.1個月，接受緩解性手術者存活期為13.5個月，術後接受輔助性化療者存活期為19.8個月。死亡風險評估方面，接受新輔助化療者死亡風險是無治療者的0.64倍，接受傳統輔助化療者死亡風險是無治療者的0.54倍，接受根治性手術者死亡風險為無治療者的0.38 倍，接受緩解性手術者死亡風險為無治療者的0.59倍。研究結果亦顯示手術及化療皆可降低胰臟癌死亡風險，並可延長其存活期。結論與建議年齡、診斷位置、腫瘤分期、手術類型及治療模式皆為影響胰臟癌病患醫療資源耗用的重要因子，其中以第四期胰臟癌病患影響程度最大，可能原因為第四期病患於住院期間需接受多種治療，包含接受新輔助型化療因而使其住院費用相對增加。治療前醫療團隊需有完善評估以提供患者個別化適當治療，並縮短其住院天數及減少醫療費用。本研究追蹤胰臟癌病患存活情形，發現經由適當醫療處置可延長病患存活期，並降低不必要花費。此外，治療期間需再仔細評估病患臨床情況，以減少因藥物毒性引起的併發症。

關鍵字

胰臟癌；醫療資源耗用；死亡率台灣

並列摘要

Background and purpose Occupying the fourth mortality of cancer at western ountries ,pancreas cancer accounts for about 6% of the death toll of all cancers, with a rising incidence in recent years. In Taiwan, according to the statistical data from National Health Administration in 2012, mortality of pancreas cancer had become the eighth place by the ninth place concerning the cause of death. Most pancreas cancer occurs at age above 50, with linear increasing incidence. The five-year survival rate of pancreas cancer was estimated to be about 20%, and the mortality was up to 95%. Therefore,this study purposed to explore the temporal trend and predictors of outcomes among pancreatic cancer patients. Materials and methods A total of 248 patients diagnosed with pancreas cancer between January 2008 and December 2013 were retrospectively evaluated in one medical center. T-test,chi-square test, one-way ANOVA, multiple regression were used to examine the relationships between medical utilization and risk factors. Survival data were analyzed using Kaplan–Meier curves and Cox-regression. Statistical evaluations were performed using SPSS 20.0 (SPSS Inc., Chicago, IL, USA). Results One hundred and fourty-seven males and 101 females with a mean age of 64.4 were included in this study.In recent years,significantly increased hospitalization and chemotherapy costs from pancreas cancer patients revealed the increasing phenomena of chemotherapies and relevant therapies in hospitalization. Remarkable factors affecting lengths of stay (LOS) included age, position of neoplasm, type of surgery and modality of treatment. The pancreas cancer patients with stage IV had greatest impact on LOS, which might be contributed to multiple therapies during hospitalization, inclusive of new auxiliary chemotherapy. Survival analysis also showed that the survival rates of overall patients, patients who underwent soothed surgery, and patients who received surgery as well as auxiliary chemotherapy were 12.1 months, 13.5 months, and 19.8 months, respectively. In comparison with patients without treatment, patients who received new auxiliary chemotherapy, patients who received traditional auxiliary chemotherapy, patients who underwent radical surgery,and patients who underwent soothed surgery showed a significantly lower mortality rate than their counterparts (odds ratios 0.64, 0.54, 0.38, and 0.59, respectively). The result revealed both surgery and chemotherapy could reduce mortality rate of pancreas cancer patients and prolong their survival period. Conclusion and recommendations Healthcare providers and patients should recognize that attributes of both the patient attributes and the hospital attributes may affect hospital resource utilization and mortality rates. The results are relevant not only to other countries with a similar population size, but also to countries with larger populations. Additionally, careful reevaluation of the patient’s clinical status was imperative to reduce complications caused by medicine toxicity.