後期肺癌病患使用化學療法之存活評估

Evaluating Survival Outcome for Chemotherapy in Advanced Lung Cancer Patients

林佩怡(Pei-Yi Lin)

指導教授 ： 楊奕馨

高雄醫學大學/藥學院/藥學研究所碩士在職專班/碩士(2013年)

摘要

目的:肺癌是近幾年國人癌症死亡的首位，也是致死率高的癌症之一。肺癌致死率高主要是因大部分病患發現時已經是晚期，而無法做有效的積極治療，以提高病患的存活率。在肺癌晚期的治療，以單一化學藥物為首選治療方針。本研究旨在探討使用化學藥物與肺癌病患的存活與其使用對疾病進展的控制。
方法:採回溯性追蹤研究，利用國衛院健保資料庫的2003年至2010年的資料，利用ICD-9CM診斷碼為162.0-162.9的肺癌患者，並僅有接受單一化學藥物治療者納入分析，統計分析利用存活分析方法Kaplan-Meier estimates 和Cox proportional hazard model針對存活率及藥物治療效果作評估。
結果:從健保資料庫中擷取2003年至2010年新診斷的肺癌患者有55,136人，其中有1,964人使用單一化學治療而進入研究，男性1,419人占67%、女性545人占33%，年齡分布以60-79歲占最多人數。化學治療處方分成三組，使用gemcitabine有1,253人，vinorelbine有336人，docetaxel有375人。使用vinorelbine的治療組有較高的存活期31.4週。老年比年輕患者有較長的存活期。三組化學治療處方之中位數存活期和一年存活率分別是doetaxel組16.8週和34%，gemcitabine組21.1週和31%，vinorelbine組是31.4週和37%；docetaxel和gemcitabine分別和vinorelbine比調整過的hazard ratio，分別是1.45 (95% CI 1.17-1.79, p<0.05)、1.09(95% CI 0.91-1.31, p=0.31)。結論:本研究顯示使用單一化學藥物治療影響肺癌後期患者的治療與性別、年齡、治療模式與化學療程有顯著性的關係。肺癌後期患者在三組化學療程中vinorelbine有顯著的治療效果。

關鍵字

肺癌 ； 化學治療 ； 存活分析

並列摘要

Objective:Lung cancer is the leading cause of cancer mortality in the world. Majority of lung cancer death is mainly due to being diagnosed at an advanced stage, and hence, one cannot apply effective treatment to improve the survival rate of patients. The preferred treatment approach for advanced lung cancer patients is, a single chemotherapy drugs. The purpose of this study is to explore the association of chemical drugs and survival rates of lung cancer patients.
Methods:The study adopts a retrospective cohort study design based on the National Health Insurance Research Database (NHIRD) from 2002 to 2011. Medical records of newly diagnosed lung cancer (ICD-9-CM 162.0-162.9) patients from 2003-2010 were extracted. Demographic characteristics, comorbidities, treatment patterns, and pattern of chemotherapy were analyzed. The total medical utilization was evaluated using descriptive statistics which incorporates sex, age and single agent therapy. Kaplan-Meier estimates were used to construct survival curves, and Cox proportional hazard model was used to evaluate hazard ratios.
Results:There were 55,136 newly diagnosed lung cancer patients during 2003-2010 identified from NHIRD. Among them, 1,964 patients were treated by single therapy. There were 1,419 (72.3%) males and, 545 (27.7%) females. The average age was 71.1(?b10.4) years old. Treatment patterns are received chemotherapy only based. Chemotherapy prescriptions were divided into three groups, 375 patients in docetaxel, 1253 patients in gemcitabine, and 336 patients in vinorelbine group. Using vinorelbine group has higher average of survival time 31.4 (23.6-39.1) weeks than other groups. Elderly patients had a longer survival time than younger patients. Median and 1-year survival were 16.8 weeks and 34% in docetaxel group, 21.1 weeks and 31% in gemcitabine group, and 31.4 weeks and 37% in vinorelbine group.
Conclusion:The study found that gender, age, treatment, and chemotherapy regimens are significant factors for the survival of NSCLC patients. Vinorelbine of three chemotherapy regimens offered a significant advantage over the others in the treatment of advanced lung cancer.

並列關鍵字

Lung Cancer ； Chemotherapy ； Survival Analysis

參考文獻

參考文獻

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