癌症術前及術後輔助治療模式對存活與生活品質之影響—以直腸癌切除術病人為例

Effects of Patterns of Neoadjuvant and Adjuvant Therapy on Survival and Quality of Life – Using Patients Received Resection for Rectal Cancer as an Example

張慧如(Hui-Ru Chang)

指導教授 ： 楊銘欽 ； 鍾國彪

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2012年)

https://doi.org/10.6342/NTU.2012.01968

摘要

前言：直腸癌是國內高盛行癌症之一，雖然近來在治療方法已有長足進展，但死亡率及復發率仍高，因此直腸癌的治療效益持續受到關注。然而若僅針對個別之治療方法進行探討，將過於繁雜又無法有效推估預後，因此可由整體治療模式著手，能較完整評估病人的治療效益。
目的：有鑑於直腸癌的理想治療模式仍無定論，因此本研究以直腸癌切除術病人為例，探討目前國內常見之直腸癌輔助治療模式，以及該等模式對病人存活及生活品質校正存活時間影響的差異。
方法：本研究以病人術前及術後有無接受放射線治療及化學治療來界定治療模式種類，並以行政院衛生署健康統計資料中2005-2007年間首次進行直腸癌切除術患者之健保醫療利用資料來檢視常見之治療模式，另進一步運用存活分析方法探討該等治療模式對病人整體存活率影響的差異。再者，本研究另使用EQ-5D問卷調查台灣北部二家醫學中心2006-2009年間直腸癌切除術患者之生活品質，以蒙地卡羅估計法估算與比較各類治療模式病人的生活品質校正存活時間。
結果：本研究歸類常見之直腸癌治療模式包括模式1：術前術後均無輔助治療、模式2：術後放化療、模式3：術後化療、模式4：術前術後均放化療、模式5：術前放化療且術後化療、模式6：術前放療且術後放化療、模式7：術前放化療、模式8：術前放療且術後化療。在各模式對病人預後的影響上，早期個案以接受模式7 (術前放化療)或模式1 (術前術後均無輔助治療)者之整體存活率及生活品質校正存活時間有較佳的表現；而晚期個案則以接受模式6 (術前放療且術後放化療)、模式5 (術前放化療且術後化療)、或模式4 (術前術後均放化療)個案之預後佳。此外，本研究結果亦發現最常見之治療模式(模式2) 之存活率及生活品質校正存活時間並非最佳。
結論：本研究結果顯示不同治療模式確會為病人帶來不同之治療效益。由於本研究不僅使用全國性資料來分析治療模式對直腸癌整體存活率之影響，並進一步以生活品質進行存活時間之校正，故研究結果值得醫療服務提供者及衛生主管機關於醫療服務提供或衛生政策制訂之參考。

關鍵字

直腸癌 ； 治療模式 ； 輔助治療 ； 生活品質 ； 存活分析

並列摘要

Introductions: Rectal cancer is one of the most incident forms of cancer in Taiwan. Mortality and recurrence rates of rectal cancer are still high despite the improvements in treatments, and therefore there are increasing concerns regarding the benefits of treatments. The approach to analyze each treatment complicates the studies and cannot estimate the prognosis precisely. Instead of specific treatment, focusing on patterns of care is considered to be more complete.
Objectives: To explore the frequent patterns of pre- and post-operation adjuvant therapies for rectal cancer and to evaluate the effects of these patterns on survival and quality adjusted survival time.
Methods: First, the nationwide Health Insurance Database in Taiwan was used to explore frequent patterns of care for patients received resection for rectal cancer during 2005-2007, and further survival analysis was used to determine if patterns of care affecting overall survival. Secondly, patients received resection for rectal cancer from two medical centers during 2006-2009 were retrieved. Their quality of life was measured using the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D) and Monte Carlo method was applied to estimate the quality adjusted survival time for patients received different patterns of care.
Results: The frequent patterns of care for rectal cancer were pattern of resection without any adjuvant therapy, pattern of postoperative radiotherapy and chemotherapy, pattern of postoperative chemotherapy, pattern of pre- and postoperative radiotherapy and chemotherapy, pattern of preoperative radiotherapy and chemotherapy and postoperative chemotherapy, pattern of preoperative radiotherapy and postoperative radiotherapy and chemotherapy, pattern of preoperative radiotherapy and chemotherapy, and pattern of preoperative radiotherapy and postoperative chemotherapy. Survival and quality adjusted survival time of patients with early-stage rectal cancer received pattern of preoperative radiotherapy and chemotherapy or pattern of resection without any adjuvant therapy were better than that of other patterns. Survival and quality adjusted survival time of patients with advanced-stage rectal cancer received the pattern of preoperative radiotherapy and postoperative radiotherapy and chemotherapy were better than that of other patterns.
Conclusions: The present study shows that there are differences in the effects of frequent patterns of care on prognosis for rectal cancer patients. The findings can be implications for health care policy and practice.

並列關鍵字

rectal cancer ； pattern of care ； adjuvant therapy ； quality of life ； survival analysis

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