台灣地區大腸直腸癌病患存活率之分析

Survival Analysis with Colorectal Cancer Patients in Taiwan

孫麗珠(Li-Chu Sun)

指導教授 ： 章順仁

高雄醫學大學/醫學院/醫學研究所/碩士(2008年)

https://doi.org/10.6832/KMU.2008.00019

摘要

台灣地區大腸直腸癌的發生率及死亡率有逐年增加的趨勢，根據許多研究所公佈的存活率有許多差異性。本研究的目是藉由存活率的分析，並進一步探討影響存活率的預後因子。本研究以病歷回溯世代性分析，以高雄醫學大學附設中和紀念醫院為對象，收集自1995年1月至2006年6月在本院胃腸及一般外科診斷為大腸直腸癌，並接受外科手術切除惡性腫瘤的病例共1282人，以人口學特徵、病患的臨床症狀以及生化檢驗值，與衛生署死亡檔作癌症相關存活率及預後分析。本研究結果以Kaplan-Meier分析大腸直腸癌相關死因的五年存活率為60.40%，第一、二、三、四期大腸直腸癌相關死因之五年存活率分別為90.06%、72.19%、60.33%、11.99% (P<0.001)，以Cox proportion hazard model分析影響預後的獨立因子為癌症分期(P<0.001)以及術前血清中癌胚胎抗原值(CEA)(P<0.001)。患者同時罹患糖尿病時，身體質量指數(BMI)也是獨立的預後因子(P=0.017)。化學治療(P<0.001)以及術前血清中CEA值(P<0.001)是第三及第四期患者預後的獨立影響因子。研究結果證實影響大腸直腸癌病患存活率的預後因子是癌症分期以及手術前血清中CEA值；大腸直腸癌第三期及第四期之病患有施行化學治療，以及大腸直腸癌且同時罹患糖尿病時，若BMI值大於等於22 kg/M2時，其預後較好。

關鍵字

大腸直腸癌 ； 存活分析 ； 預後因子

並列摘要

The incidence and mortality rate of colorectal cancers are increasing annually in Taiwan, but a variation of survival rate in other studies is observed. The purpose of the present study is to investigate the relationship between the various factors and survival in colorectal cancer patients following surgical resection, and further to identify the high-risk factors for these patients. Between January 1996 and June 2006, 1282 patients with histologically proven colorectal cancer receiving surgical resection were enrolled into this study. Patients’ clinical outcome and survival status were regularly followed up till December 2006. Demographic data, clinical symptoms, biochemistric measurement and cause of death was determined by Department of Health were used for the survival and prognostic analysis. Using Kaplan-Meier survival analysis, the overall cancer-related five year survival rate was 60.40% in our analysis. Furthermore, the 5-year survival rate for UICC stage I, II, III and IV were 90.06%, 72.19%, 60.33% and 11.99%, respectively (P<0.001). Cox proportion hazard model revealed that independent prognostic factors were UICC stage (P<0.001) and carcinoembryonic antigen (CEA) value (P<0.001). When the patient simultaneously suffers from diabetes, the body mass index (BMI) value was also an independent prognostic factor (P=0.017). Adjuvant chemotherapy (P<0.001) and CEA value (P< 0.001) were independent prognostic factors for UICC stage III and IV colorectal cancer patients. The UICC Stage and preoperative CEA level are independent prognostic factors following surgical resection for colorectal cancer. The better clinical outcome was observed in patients who have undergone chemotherapy for UICC Stage III and IV colorectal cancer patients and when the patient simultaneously suffers from diabetes with BMI value ≥ 22 kg/M2.

並列關鍵字

Colorectal cancer ； survival rate ； prognostic factor

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