Mortality Risk and Related Factors of Stage I Colorectal Cancer Patients Death Risk and Related Factors in Stage I Colorectal Cancer Patients: A Nationwide Population-based Study

第一期大腸直腸癌死亡風險及其相關因素

謝明皓(Ming-Hao Hsieh) ； 龔佩珍(Pei-Tseng Kung) ； 郭娓吟(Wen-Yin Kuo) ； 柯道維(Tao-Wei Ke) ； 蔡文正(Wen-Chen Tsai)

《中華民國大腸直腸外科醫學會雜誌》 31卷3期 (2020/09) Pp. 168-177

https://doi.org/10.6312/SCRSTW.202009_31(3).10905

摘要

Purpose. In Taiwan, incidence of colorectal cancer ranks first among the top ten cancers and its mortality ranks third. Probability of post-treatment recurrence or metastasis is low in early-stage colorectal cancer patients. However, clinical observations exhibit an increased mortality risk for some early-stage colorectal cancer patients, possibly owing to lack of follow up by medical units or other risk factors. We aimed to examine the mortality risk and ratio and mortality-related factors in stage I colorectal cancer. Methods. This retrospective study included patients registered at the Tai-wan Cancer Registry of the Health Promotion Administration during 2007-2012. The database was linked to the National Health Insurance Research Database; subjects were followed up until the end of 2016. Mortality risk and other related factors in stage I colorectal cancer patients were evaluated using bivariate analysis (log-rank test and Cox proportional hazards model) according to demographic characteristics; economic, environmental, and health factors; treatment modalities and hospitals; and absence/presence of periodic follow up. Results. The 5-year mortality rate of stage I colorectal cancer was 2.54%. Risk factors for stage I colorectal cancer mortality were prevalent in patients aged ＞ 75 years with comorbidity index ≥ 2 points and presence of rectal lesions. Conversely, undergoing one or more colonoscopies within 2 years after surgery can reduce stage I colorectal cancer risk. Conclusion. Age, comorbidity index, and tumor site are significantly related to the prognosis of stage I colorectal cancer, and periodic colonoscopy can decrease the mortality risk of stage I colorectal cancer.

關鍵字

Stage I colorectal cancer ； Mortality risk ； Risk factors

並列摘要

目的：台灣大腸直腸癌發生率在癌症中排行第一，死亡人數占第三位。早期大腸直腸癌病患經治療後復發或轉移的機會並不高，但在臨床觀察上，仍可發現少數早期病人，可能因醫療單位及病人過於輕忽而疏於追蹤，或其他危險因子造成死亡風險上升。本研究欲探討第一期大腸直腸癌病患死亡的風險及比率，及探討其死亡之相關因子。方法：本研究為回朔性研究，以2007-2012年，國健署癌症登記檔所登記的第一期大腸直腸癌為對象，串聯健保資料庫，追蹤至2016年底。第一期病患死亡風險的評估將分別採用雙變項分析（log-rank test）及Cox比例風險模式（cox proportional hazard regression），並依照病患之人口學特性、經濟因素、環境因素、健康因素、治療方式和治療醫院，及有無定期追蹤等來分析相關的危險因子。結果：本研究顯示大腸直腸癌一期病患的五年因大腸直腸癌特定死亡率為2.54%。死亡危險因子則分別年紀大於75歲、共病指數2-3分、共病指數≥ 4分、直腸病灶。反之，如果術後兩年內有做一次或兩次以上大腸鏡檢查，可降低第一期大腸直腸癌死亡的風險。結論：由本研究可知，年紀、共病指數、腫瘤位置、和第一期大腸直腸癌病患預後有明顯相關，而定期接受大腸鏡檢查，可以降低第一期大腸直腸癌的死亡風險。

並列關鍵字

第一期大腸直腸癌 ； 死亡風險 ； 危險因子

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