摘要
染髮劑至今已被廣泛的使用，但染髮劑對於人體之安全性仍受爭 議。據估計歐洲、北美及日本，有三分之ㄧ年齡18 歲以上的女性與 10%年齡40 歲以上的男性都曾經染過頭髮。許多流行病學研究發現 使用染髮劑之習慣會增加癌症的危險性，但很少研究探討染髮劑之使 用與攝護腺癌之關係。 本研究目的是探討國人男性罹患攝護腺癌與危險因子之相關 性，以及相關危險因子對男性罹患攝護腺癌預後之影響與存活分析。 本研究設計分為兩大部份，第一部分採用以醫院為主的病例對照 研究法，於民國89 年8 月至97 年12 月間，從高雄醫學大學附設中 和醫院與高雄榮民總醫院共收集年齡50 至90 歲394 位新診斷且病理 證實為攝護腺癌之病例組，546 位診斷未罹患癌症之健康男性為對照 組，以結構式問卷進行調查社經人口學資料與染髮習慣等。病例組排 除患有其他癌症以及種族配對後，最後共剩下296 位病例組與296 對照組進入本研究，並用邏輯斯回歸分析探討攝護腺癌之相關危險因子。第二部份為探討攝護腺癌病患預後與存活分析，於89 年8 月至民國96 年12 月止，從上述兩家醫院與台灣大學醫學院附設醫院收集608 位攝護腺癌病患，同樣採用問卷進行調查並連結全國死亡登記 檔，以邏輯斯回歸分析探討攝護腺癌臨床分期與病理分級(Gleason score)之相關危險因子，Cox 多變量迴歸分析來探討各危險因子與攝護腺癌病患存活之相關性。 本研究結果發現有染髮習慣者相對於未曾染髮者有較高的攝護 腺癌危險性(Adjusted odds ratio(AOR)＝1.84, 95% CI＝1.08-3.15)，持 續染髮超過10 年者相對於未曾染髮者，其相對危險性為2.66 (95% CI ＝1.23-6.01)，每年染髮次數超過6 次相對於未曾染髮者的危險性則為 2.23 (95% CI＝1.04-4.92)。根據許多研究指出染髮劑中所含之芳香胺 類物質在體外實驗有致突變性，在動物及臨床試驗發現有致癌性，因 此，染髮劑可能會導致攝護腺癌發展的原因之ㄧ。本研究之病例對照 研究法結果得知染髮會增加攝護腺癌的危險性，而其後攝護腺癌患者 之預後與存活分析卻未發現兩者之相關性，但發現規律運動習慣會降 低攝護腺癌預後危險性及死亡率。 本研究發現染髮習慣可能為罹患攝護腺癌的危險因子，罹患攝護 腺癌前病患有規律運動習慣對於預後及存活是有保護之關係。日後需 進一步探討其生物學上的機轉。
並列摘要
Hair dye is widely used. It has been estimated that over one-third of women above the age of 18 years and over 10% of men above the age of 40 years use hair dye in Europe, North America and Japan. Several cohort and case-control studies have found hair dye usage increased cancer risk, but rare epidemiologic studies have showed the relationship between hair dye usage and prostate cancer. The aims of our research are to investigate the relationship between hair dye usage and prostate cancer risk and the influence of relative prostate cancer risk factors on disease characteristics and prognosis. First, we conducted a hospital-based case-control study to investigate the risk factors of prostate cancer in Taiwan. In total, 394 pathology-proved prostate cancer patients and 546 male controls, age 50 to 90 years, were recruited from Kaohsiung Medical University Hospital (KMUH) and Kaohsiung Veterans General Hospital (KVGH) between August 2000 and December 2008. Subjects were interviewed in-person with a structured questionnaire including social-demographic characteristics, lifestyle and hair dye usage. After excluding cases with other cancers and individual matching by ethnicity, remain 296 cases and 296 controls were into final statistic analysis. Multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals (95% CI) with adjustment for multiple covariates. Second, 608 pathology-proved prostate cancer patients were recruited form KMUH, KVGH and National Taiwan University Hospital (NTUH) between August 2000 and December 2007. Subjects were also interviewed in-person with a questionnaire. The clinical characteristics and cancer-specific death were obtained. Multivariable logistic regression is used to analyze the influence of these risk factors on disease stage and Gleason Score. Kaplan-Meier survival curve analysis and Cox proportional hazards model were used to evaluate the relation between these risk factors and cancer-specific survival of prostate cancer patients. Subjects who had used hair dye were 1.84 times (95% CI=1.08-3.15) more likely to develop prostate cancer than those who had never used. Men who had used hair dye over 10 years compared to those who had never used had 2.66-fold risk (95% CI=1.23-6.01). The significant increased risk in men who had used hair dye over 6 times per year was 2.23 times (95% CI=1.04-4.92) when compared to those who had never used. According to some studies indicated that some aromatic amines contained in hair dye products are mutagenic in vitro and are carcinogenic in animals and humans which may also constitute to the development of prostate cancer. Although hair dye usage was positive association with prostate cancer in our case-control study, it did not influence prostate cancer prognosis and survival. We found that regular exercise is negative association with prostate cancer risk and cancer-specific mortality. Our results suggest that hair dye usage may be associated with the risk of prostate cancer and regular exercise may be a protective factor for the development of prostate cancer and patients’ survival. Further large-scale studies are needed to confirm our study and clarify the biological mechanisms.