- 學位論文
探討台灣男女性氣喘、慢性阻塞性肺部疾病及肺結核與肺癌之相關性研究:以全國人口為基礎
Association between asthma,chronic obstructive pulmonary disease,lung tuberculosis and lung cancer by gender in Taiwan:A Nationwide Population-Based Study
摘要
過去之研究大多探討肺部疾病例如氣喘、慢性阻塞性肺部疾病及肺結核爾後發生肺癌之關係，鮮少有研究在探討同時存在多種肺部疾病與不同肺癌組織病理型態之間的關係。本研究主旨在探討台灣男、女性罹患氣喘、慢性阻塞性肺部疾病及肺結核與不同肺癌組織病理型態之相關性，並進一步探討同時存在多種肺部疾病者是否有較高的危險爾後發生肺癌。 數據之取得來自國家衛生研究院釋出之全民健康保險研究資料庫(NHIRD)，2001-2008年間共有15,219,024位20歲以上在保者納入研究，以2001-2003年間患有肺部疾病包含氣喘、慢性阻塞性肺部疾病及肺結核者追蹤至2008年來探討有無肺癌之發生。本研究使用Cox比例風險迴歸模式(Cox Proportional Hazard Regression Model)估算罹患肺部疾病與爾後肺癌發生之危險對比值(Hazard Ratio, HR)，所有模式皆調整年齡層、低收入戶、居住地理區域、都市化程度與共病症等干擾因子。 在調整干擾因子後，男性單獨罹患氣喘、慢性阻塞性肺部疾病及肺結核與肺鱗狀細胞癌其危險對比值為1.81、1.82及1.73，女性為1.61、1.51及3.64，男性單獨罹患氣喘、慢性阻塞性肺部疾病及肺結核與肺腺癌其危險對比值為1.31、1.59及1.64，女性為1.28、1.40及1.82，男性單獨罹患氣喘、慢性阻塞性肺部疾病及肺結核與小細胞肺癌其危險對比值為1.84、1.57及1.65。男性單獨罹患氣喘、慢性阻塞性肺部疾病及肺結核與肺癌其危險對比值為1.57、1.68及1.81，女性為1.35、1.38及1.96，男、女性過去同時罹患氣喘+慢性阻塞性肺部疾病+肺結核與肺癌其危險對比值分別為2.81及2.96。 本研究結果顯示不論男、女性，單獨罹患氣喘、慢性阻塞性肺部疾病及肺結核者會增加爾後罹患肺癌的危險，特別是在肺鱗狀細胞癌及肺腺癌，且罹患多種肺部疾病者比單獨罹患一種肺部疾病者爾後發生肺癌的危險性較高。
並列摘要
The effect of pulmonary diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung tuberculosis (TB) on subsequent lung cancer have been reported, but few studies have focused on the association of coexisting pulmonary diseases in different histologic types of lung cancer. This study was conducted to investigate the association between pulmonary diseases and different histologic types of lung cancer and further explored whether the coexisting pulmonary diseases have a higher risk of lung cancer based on gender. The data used in this study was extracted from the National Health Insurance Research Database (NHIRD) from 2001-2008, which was provided by the National Health Research Institute. A total of 15,219,024 residents aged 20 years and older, who had pulmonary diseases from 2001-2003, were identified and tracked until when they developed lung cancer or to the end of 2008. The Cox proportional hazard regression model was used to assess the risk of developing lung cancer by histologic type, with adjustment for the age group, low income, geographic area, urbanization and comorbidities. After adjustment for confounders, the HRs of squamous cell carcinoma in males were 1.81 for Asthma, 1.82 for COPD and 1.73 for TB, whereas those for females were 1.61 for Asthma, 1.51 for COPD and 3.64 for TB. The HRs of adenocarcinoma in males were 1.31 for Asthma, 1.59 for COPD and 1.64 for TB, while those in females were 1.28 for Asthma, 1.40 for COPD and 1.82 for TB. The HRs of small cell carcinoma in males were 1.84 for Asthma, 1.57 for COPD and 1.65 for TB. For lung cancer, the HRs in males were 1.57 for Asthma, 1.68 for COPD and 1.81 for TB, while those in females were 1.35 for Asthma, 1.38 for COPD and 1.96 for TB patients. The HRs in males were 2.81 for Asthma+COPD+TB patients and were 2.96 in females with Asthma+COPD+TB. The study shows that Asthma, COPD and TB were associated with increased risks of squamous cell carcinoma and adenocarcinoma. Patients with coexisting pulmonary diseases were more susceptible to certain histologic types of lung cancer.