肝癌患者施行肝動脈化學栓塞後療效與醫療資源利用的探討

The Outcomes and Resource Utilization of Hepatocellular Carcinoma Patients Underwent Transcatheter arterial chemoembolization

劉大忠(Ta-Chung Liu)

指導教授 ： 邱亨嘉

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2009年)

摘要

目的
肝癌為台灣男性癌症死因的第一位，女性的第二位，對於無法施行肝癌切除
術的肝癌病患而言，肝動脈化學栓塞療法（transcatheter arterial chemo
embolization, TACE）是現今被視為最具積極性之治療方式，國內外鮮少以TACE
作有關醫療資源利用的探討，本研究以某一家區域教學醫院作過TACE 的肝癌病
患，探討治療後療效和醫療資源利用，並探討TACE 技術的成熟度對療效和醫療
資源利用的影響。
研究方法
研究樣本採病例審查回溯性分析，以 2000 年1 月到2008 年12 月間，在某
區域教學醫院作過TACE 的病人為對象，以病例審查方式取得治療變項，費用則
取自於醫院中數據。利用Kaplan-Meier 和Cox regression 分析2000 年到2005
年間執行TACE 病人的一、二、三年存活率和其重要的影響因子，以複迴歸分析
探討合併症及併發症對於住院天數和醫療費用的影響，以獨立樣本T 檢定則在檢
定TACE 成長期（2000-2004 年），成熟期（2005-2008 年）其資源利用的差異性。
統計以SPSS 統計軟體進行分析。
研究結果
共有123 名病患接受了553 次的TACE 治療，平均每人4.5 次，平均年齡為
60.9±14.2 歲，疾病特質中，58 人有B 肝，53 人有C 肝，在child，s 分類中，A、
B、C 各類分別為25、16 和6 人。123 名病患中，有合併症者58 人，有併發症者
4 人。在存活率分析（n=80），一、二、三年的存活率為76.25﹪、45﹪、31.25
III
﹪平均存活時間24 個月。影響存活率顯著的影響因子為年齡、腫瘤大小、腫瘤
數目、child，s C、AJCC 腫瘤分期、病理分級，作完TACE 一個月後AFP 下降一
半，及門靜脈栓塞。腫瘤每增加1 公分，死亡率增加1.5 倍（HR：2.529，95％
CI：1.41~4.51），多發性腫瘤患者是單一腫瘤患者死亡率的63.9 倍（HR：63.950，
95﹪CI：3.51~138.69），有門靜脈有栓塞者死亡率為沒有者的5.7 倍（HR：5.770，
95﹪CI：0.40~10.06）。複線性迴歸指出，有合併症的住院日8.69 天，沒有合併
症的住院日5.5 天，有合併症的住院醫療費用為54,931 元，無合併症的住院醫
療費用為42,729 元，有併發症者平均住院日數14.75 天，沒有併發症者平均住
院日數6.89 天，有併發症的平均花費113,793 元，沒有併發症者為47,768 元。
把TACE 技術成長期與成熟期相較，發現成長期每次住院平均花費52,047 元，而
成熟期為43,502 元；住院天數方面，成長期每次平均住院天數7.94 天，成熟期
5.7 天，二者皆有統計上顯著差異。
結論
本研究發現TACE 病人存活率大致同於其他研究，臨床醫師應增加經驗的累
積，培養更純熟的技術來降低併發症。合併症與併發症是影響住院天數和醫療費
用的主要影響因子。臨床醫師應管理合併症並避免併發症之發生。但整體而言，
技術不斷提昇，住院天數和住院總醫療費用皆有顯著下降，也提昇了醫療品質，
證明學習曲線和醫療品質之正向關係。

關鍵字

肝細胞癌 ； 肝動脈化學栓塞術 ； 醫療資源利用 ； 醫療品質

並列摘要

Objectives
Liver cancer is the first leading cause of cancer death among male Taiwanese and the
second among female Taiwanese. Nowadays, TACE is the most active treatment for
liver cancer patients who can’t receive liver resection. However, there have been rare
local and abroad researches on TACE which discussed its relevant medical resource
utilization. Thus, this study use a district teaching hospital as an example, review the
curative effect after treatment, and the medical resource utilization, we also discussed
the relationship between the maturity level of TACE technique and the medical
resource utilization.
Methods
This study adopted retrospective medical record review analysis method, which took
the patients who received TACE in this district teaching hospital between January
2001 and December 2008 as research objects. We used Kaplan-Meier and Cox
regression to calculate the one-year, two-year, three-year survival rates of patients
who received TACE between 2000 and 2005, and their important affecting factors. We
used multiple regression to analyze the effects of comorbidity and complication on the
length of stay and the medical expense of hospitalization. The independent sample
t-test was used to find out whether there’s any significant difference in the length of
stay and the medical expense of hospitalization between the two stages, the growth
stage (2000-2004) and the maturation stage (2005-2008). The data collected was
analyzed with SPSS statistics software.
Results
There were 123 patients who received 553 TACE treatments. On average, each patient
received 4.5 times, The average was 60.9±14.2 years old. Among these patients, 58
patients had hepatitis B, and 53 patients had hepatitis C. According to Child’s
classification, 25 patients were in Child’s A, 16 in Child’s B and 6 in Child’s C.
Among these 123 patients, 58 had comorbidity, and 4 had complication.In the survival
analysis（n=80）, The one-year, two-year, three-year survival rates were 76.25%, 45%
and 31.25%, respectively, and the average survival time was 24 months. The factors
which significantly affected the survival rate included age, size of tumor, number of
tumors, Child’s C, AJCC cancer staging, pathology classification, AFP reducing to
half a month after receiving TACE, and portal vein thrombosis. The death rate
V
increased 1.5 folds with the increment of tumor size by 1 cm（HR：2.529，95％CI：
1.41~4.51）. The death rate of multiple cancer patients was 63.9-fold higher than that
of single tumor patients（HR：63.950，95﹪CI：3.51~138.69）. The death rate of
patients with portal vein thrombosis was 5.7-fold higher than that of patients without
portal vein thrombosis（HR：5.770，95﹪CI：0.40~10.06）.According to our study,
the average length of stay of patients with comorbidity was 8.69 days, while that of
patients without comorbidity was 5.5 days. The average medical expense of
hospitalization for patients with comorbidity was 54,931 NT dollars, while that for
patients without comorbidity was 42,729 NT dollars. On average, patients with
complications stayed in the hospital for 14.75 days, while patients without
complication stayed only for 6.89 days. The average cost for patients with
complication was 113,793 NT dollars, while that for patients without complication
was 47,768 NT dollars. The difference in medical expense on hospitalization and the
length of stay between the growth stage and the maturation stage period, We found
that the average cost in the growth stage was 52,047 NT dollars, while it was 43,502
NT dollars in the maturation stage. For the length of stay, the average length of stay in
the growth stage was 7.94 days per hospitalization, while it was 5.7 days in the
maturation stage. There was a significant difference between the two stages as well.
Conclusions
This study found that the survival rate conformed to the level reported in the other
researches or documents. The radiologist should increase the experience and more
mature technique to decrease the complication. The study showed that comorbidity
and complication were the major factors affecting the length of stay and medical
expense for hospitalization. The clinical doctor should manage the comorbidity and
avoid the complication. But overall, both the length of stay and medical expenses for
hospitalization were significantly reduced along with time, and improved the quality
of medical care as well. It also proved that the positive relationship between the
learing cruve and medical quality.

並列關鍵字

Hepatocellular carcinoma ； Transcatheter arterial chemoembolization (TACE)

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