台灣下咽鱗狀細胞癌及食道鱗狀細胞癌發生率趨勢分析

Analysis of incidence trends of hypopharyngeal and esophageal squamous cell carcinoma in Taiwan

林世倉(Shih-Tsang Lin)

指導教授 ： 賴美淑

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.01003

摘要

背景
在台灣下咽癌和食道癌的發生率近二十年來有明顯上升的趨勢。抽菸、喝酒、嚼檳榔是主要的危險因子，這些與生活習慣相關的危險因子在年齡-年代-世代模型中大部分被歸類為世代效應。最近幾年，以全人口為基礎的研究顯示，下咽癌在口腔及咽癌中得到第二原發食道癌的風險最高。本研究主要目的在針對鱗狀細胞癌探討下咽癌和食道癌間的關係，並對於下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌的發生率趨勢加以分析。

材料與方法
以台灣癌症登記資料，取得西元1983到2007年間下咽鱗狀細胞癌和食道鱗狀細胞癌的個案，計算不同性別的年齡標準化發生率。將男性下咽鱗狀細胞癌和食道鱗狀細胞癌的發生率趨勢利用自我廻歸年齡-年代-世代模型，分別得到年齡效應、年代效應以及世代效應，來進行分析。並對男性下咽鱗狀細胞癌併發"同時性"第二原發食道鱗狀細胞癌(與第一原發癌同時診斷或診斷後六個月內發生的第二原發癌)及"異時性"第二原發食道鱗狀細胞癌(第一原發癌診斷後六個月後發生的第二原發癌)的發生率趨勢變化加以分析。

結果
在年齡-年代-世代的分析，下咽鱗狀細胞癌和食道鱗狀細胞癌有相同年齡、年代及世代效應的趨勢。世代效應是一個先降後升的趨勢，從中世代1903年開始逐漸下降，到中世代1948年才開始逐漸上升。年代效應則是從年代組1983-1987年開始就持續上升。年齡效應從一開始上升到60-64歲年齡群才有些許的下降。三者效應強弱依次為年齡效應，世代效應，最後才是年代效應。下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌的發生率同樣有持續增加的趨勢。另外，下咽鱗狀細胞癌併發同時性和異時性第二原發食道鱗狀細胞癌的發生率在西元2003-2007年間呈現相反的趨勢變化。其中，同時性第二原發食道鱗狀細胞癌的發生率呈現較之前年代增加更快的趨勢，而異時性第二原發食道鱗狀細胞癌的發生率則呈現下降的趨勢。

結論
下咽鱗狀細胞癌和食道鱗狀細胞癌的年齡-年代-世代分析結果呈現相同的趨勢，顯示兩者之間有相似的 病因，並推論有相同機轉的致癌過程。而下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌的分析呈現兩者的診斷差異日在西元2003至2007年間有明顯縮短的現象。

關鍵字

下咽 ； 食道 ； 鱗狀細胞癌 ； 發生率 ； 年齡-年代-世代模型 ； 第二原發癌 ； 同時性 ； 異時性

並列摘要

Background and Objectives
The incidence of hypopharyngeal cancer and esophageal cancer has been reported to increase in recent two decades in Taiwan. Alcohol intake, betel quid chewing, and smoking were considered to be associated to the increased trends and such lifestyle factors was regarded mostly as cohort effect in age-period cohort model. In recent population-based study in Taiwan, the risk of developing second primary esophageal cancer was showed to be highest in hypophayngeal cancer among oral and pharyngeal cancer. This study aimed to exam the relationship of incidence trends of hypopharyngeal and esophageal cancer, which focused on squamous cell carcinoma and to demonstrate the incidence trends of hypopharyngeal squamous cell carcinoma with second primary esophageal squamous cell carcinoma.

Materials and Methods
A population-based study was conducted using the database from Taiwan Cancer Registry between 1983 and 2007. Patients with hypopharyngeal and esophageal squamous cell carcinoma were identified and gender-specific age-standardized incidence rates of that were calculated. The incidence trends of hypopharyngeal and esophageal squamous cell carcinoma of men were analyzed with autoregressive age-period-cohort model. Age effect, period effect, and cohort effect were obtained respectively. The incidence trends of hypopharyngeal squamous cell carcinoma with ‘synchronous’ second primary esophageal squamous cell carcinoma (difference of diagnostic time between primary and second primary cancer is simultaneous or less than 6 months) and ‘metachronous’ second primary esophageal squamous cell carcinoma (difference of diagnostic time between primary and second primary cancer is more than 6 months) of men were also analyzed.

Results
The result showed the same pattern of age-period-cohort model in both hypopharyngeal and esophageal squamous cell carcinoma. The cohort effect decreased from mid-cohort 1903 gradually and increased from mid-cohort 1948 to mid-cohort 1973. Period effect increased persistently since time period 1983-1987. Age effect increased until age group 60-64 and then decreased slightly. Age effect was strongest, followed by cohort effect. The incidence trend of hypopharyngeal squamous cell carcinoma with second primary esophageal squamous cell carcinoma also increased. Interestingly, during time period 2003-2007, there were inverse incidence trends of hypopharyngeal squamous cell carcinoma with synchronous and metachronous second primary esophageal squamous cell carcinoma. The incidence trend of synchronous second primary esophageal squamous cell carcinoma increased more rapidly than previous periods and that of metachronous second primary esophageal squamous cell carcinoma decreased.

Conclusions
The same pattern of age-period-cohort model in both hypopharygneal and esophageal squamous cell carcinoma implies similar etiology and even mechanism of carcinogenesis. There is obvious shortening of difference of diagnostic time in hypopharyngeal squamous cell carcinoma with second primary esophageal squamous cell carcinoma during time period 2003-2007.

並列關鍵字

hypopharynx ； esophagus ； squamous cell carcinoma ； incidence ； age-period-cohort model ； second primary cancer ； synchronous ； metachronous

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