年輕頭頸癌患者治療方式及預後之比較

Comparison of Treatments and Prognosis among Young Head and Neck Cancer Patients in Taiwan

洪琬婷(Wan-Ting Hung)

指導教授 ： 何佩珊

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2012年)

https://doi.org/10.6832/KMU.2012.00115

摘要

研究背景：
在世界各國的研究文獻中，頭頸部癌症近年來有逐漸年輕化的趨
勢，在台灣的頭頸癌也有類似的情形，發生年齡年輕化的傾向原因有
許多種，然而不同年齡層患者被治療的模式及預後情況是否相同，則
需進ㄧ步探討。
研究目的：
探討台灣年輕頭頸癌患者接受各種不同治療方式的分佈及存活率比較。
研究方法：
以健保資料庫之特殊需求申請之癌症患者資料，分析自1998-2008 年診斷口腔、口咽、下咽、喉癌 (ICD-9-CM codes 140-141、143-146、148-149、161)患者，將其發病年齡分為20-44 歲，45-64 歲及65 歲以上，分別分析其發生部位、治療方式及存活情形的差異。
存活率統計分析以Kaplan-Meier 方法計算一年半、三年、五年之存活率，並比較各年齡分層之間的存活曲線是否有顯著差異（Log-rank
test），最後以迴歸模式(Cox regression)探討年輕相對於年長頭頸癌預後的相關性。
研究結果：
男性患者的比例在 20-44 歲年輕族群較高23.31%，65 歲以上年
長族群則較少20.44%；從部位和年齡來看，20-44 歲以其他和口腔之
其他及未詳細說明部位(ICD145)佔大多數40.63%，到45-64 歲仍有
37.48%，65 歲以上時則減少為26.21%，而65 歲以上則以喉部為主
27.47%；治療方面，20-44 歲多以化學放射治療合併療法及手術、化
療、放療三者皆執行為主，45-64 歲也是以化學放射治療合併療法及
手術、化療、放療三者皆執行佔多數，65 歲以上則是以僅接受手術
治療為主要治療方法。本研究發現，男性年齡層、部位、治療的死亡
危險比，20-44 歲年輕族群相對於65 歲以上年長族群死亡危險比是
0.71 倍(95%CI=0.44~1.15, p=0.1686)，45-64 歲族群相對於65 歲以上年長族群死亡危險比是0.64 倍(95%CI=0.43~0.94, p=0.0213)；治療方式則是化學放射治療合併療法對照僅接受手術治療的死亡危險比是5.77 倍最高(95%CI=3.30~10.11，p <.0001)。
結論：
本研究調查結果也顯示台灣頭頸癌呈現年輕化的趨勢，男性五年
整體存活率20-44 歲年輕族群55.95%高於65 歲以上年長族群
47.30%；女性五年整體存活率20-44 歲年輕族群74.05%高於65 歲以
上年長族群50.11%。男性45-64 歲中年族群相對於65 歲以上年長族
群的死亡危險低36%，而20-44 歲年輕族群則調整後在整體及各治療
部位其死亡的危險相對於 65 歲以上族群皆未達統計顯著性差異，因
此臨床上年輕頭頸癌患者的治療，統計上並未顯示有較優勢的存活情
形。

關鍵字

頭頸癌 ； 年輕 ； 存活率趨勢

並列摘要

Background:
The increasing trend of young head and neck cancer patients has been reported in several countries. A similar trend can also be found in Taiwan. Although several reasons could contribute to the trend of younger age at first diagnosis, it would also be of interest to compare treatments and prognosis of young patients with other age groups.
Objective：
The objective of this study is to investigate young patients for head and neck cancer, and to compare distributions of a variety of different treatment modalities and survival rates.
Methods:
A population-based cohort study was designed by obtaining an 11-year longitudinal database (1998-2008) of head/ neck cancer patients from the Health Insurance Research Database in Taiwan. Patients with diagnosis of ICD 9 (International Classification of Diseases, revision 9)code140-141,143-146,148-149, and 161 were retrieved, and data were
classified into 3 age groups (20-44, 45-64, and 65 or older) according to their age of first diagnosis. Survival analysis of Kaplan-Meier estimates,Log-rank test and the Cox regression were used to compare prognosis and related factors among different age groups.
Results:
There were more male patients in the group aged 20-44 (23.31%)than in the group of 65 years or older (20.44%). More young patients(aged 20-44 years) had cancer sites of other and unspecified parts of mouth (ICD145)(40.63%), then the group of 45-64 years of age (37.48%)and the group of 65 years or older (26.21%). The majority of the 20- to-
44- year-old patients had concomitant chemoradiotherapy and multiple treatments containing surgery and chemoradiotherapy. The group of 45-to 64 year- olds had more concomitant chemotherapy and radiotherapy,
and multiple treatments containing surgery and radiotherapy and chemotherapy. The majority of patients 65 years old or older only underwent surgery. After adjusting for income, living area, cancer site and treatment in Cox regression, the hazard ratio for the group of 20- to 44-year- olds was 0.71 (95% CI = 0.44 ~ 1.15, p = 0.1686) and was 0.64(95%CI=0.43~0.94, p=0.0213) for those aged 45-64 when compared with patients of 65 years old or older. The hazard ratio for treatment of concomitant chemoradiotherapy was 5.77- fold (95% CI = 3.30 ~ 10.11, p<.0001) when compared with surgery only.
Conclusion:
This study confirmed that growing trend of young head and neck cancer patients in Taiwan. The five-year survival rate of 20- to 44 - year older patients was 55.95%,which was higher than 47.30% in 65 years old or older patients in males. Similarly,the 5-year survival rate for females patients of 20- to 44 - years of age was 74.05%,which was higher than the group of 65 years old or older(50.11%). In male patients,after adjusting for possible confounders, the age group of 20 - 44 years of age did not show any significant differences in overall or treatment/site subgroups as compared with the older age group. Clinically, the younger patients did not significantly have benefit in prognosis.

並列關鍵字

Head and neck cancer ； young ； survival rate ； trends

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