食道癌病人發生第二原發腫瘤之危險及預後因子之探討

背景及目的：2015年台灣癌症登記年報統計食道癌為男性發生率第六名，死亡率第五名。文獻指出若器官長期暴露共同致癌物，易造成癌症區域化，診斷食道癌時同時發生第二原發癌症之機率相對高，本研究目的為探討食道癌病人發生第二原發腫瘤之危險因子，找出易發生第二原發腫瘤之族群及五年累計存活率之差異，期能於早期篩檢出此類族群，接受最適切之治療。方法：資料來源為2010-2016南部某準醫學中心癌症登記資料庫個案，排除確診食道癌前有其他癌症，共521位個案，第二原發腫瘤以Warren and Gates提出之標準，並依美國癌症協會（AJCC）於 2017年發行AJCC Cancer Staging Manual 8th以四個月區分是否為同時性第二原發腫瘤，單變量統計類別變項採卡方檢定，連續變項採ANOVA檢定，將單變量p＜0.005之變項進行羅吉斯迴歸，找出發生第二原發腫瘤風險變項，並以Kaplan-Meier進行五年存活率分析及Cox迴歸預測死亡風險模型。結果：單一原發腫瘤年齡平均數為54歲，第二原發腫瘤年齡平均數為51歲，控制其他相關因素後，發現年齡每增加一歲，發生第二原發腫瘤的勝算是發生第二原發腫瘤的0.969倍；食道頸部及上段發生第二原發腫瘤是食道多顆腫瘤的0.216倍，食道中段是食道多顆腫瘤的0.270倍，食道下段是食道多顆腫瘤的0.226倍，確診之後持續喝酒相比未曾喝酒發生第二原發腫瘤是持續喝酒之0.236倍；各期無發生同時性第二原發腫瘤人數及五年累計存活率分別為第I期33人；72.9%，第II期38人；59.8%，第III期238人；21.9%，第IV期97人；0.0%；發生同時性第二原發腫瘤人數及五年累計存活率分別為第I期43人；39.5%，第II期20人；10.0%，第III期37人；22.0%，第IV期15人；0.0%。結論：年齡、食道腫瘤位置、持續喝酒行為是食道癌產生第二原發腫瘤的重要預測因子第I期及第II期有無發生第二原發腫瘤存活差異大，第III期及第IV期則存活差異不大，唯有早期發現第二原發腫瘤，早期進行治療，才能提升病患存活率。

關鍵字

食道癌；第二原發腫瘤；危險因子；預後因子

並列摘要

Objective: According to the 2015 Taiwan Cancer Registry Report, esophageal cancer was the sixth commonest cancer and the fifth leading cause of death in male population. It was well known that cancer fieldization frequently develops with long-term exposure to the carcinogens, for example, cigarette and alcohol. When diagnosing with esophageal cancer, there is a relative high possibility to be with second primary cancer at the same time. The purpose of this study is to figure out the risk factors of second primary tumor in patients with esophageal cancer and calculate the five-year survival rate. Then, an evidence-based screening protocol can be built up to make early diagnosis and good management with better survival. Methods: The data is from the Cancer Registry database of a quasi-medical center in the southern Taiwan between 2010-2016. Five hundred and twenty one patients were excluded because they had histories of other malignancies before the diagnosis of esophageal cancer. For second primary cancer was diagnosed within 4 months after the diagnosis of esophageal cancer, it is classified as the synchronous cancer, otherwise, it categorized as a metachronous tumour. This is based on the AJCC Cancer Staging Manual 8th edition, publishing in 2017. For univariate analysis, Chi square test was done for category variable and ANOVA for interval variable. It is statistically significant when p value is less than 0.05. Those significant variables were be put into multivariable analysis. We used logistic regression analysis for identifying the chance of developing second primary cancer. For survival analysis, Kaplan-Meier method was used. Five-year survival was calculated. The log rank testwas used for univariate and Cox regression was used for multivariate analysis. Result: The mean age of patients without second primary tumor was 54 years old, and it was 51 years old for those with. The odds ratio was 0.969 when diagnosing with esophageal cancer each year older. In comparison with patients having multiple focus of primary esophageal cancer, the odds ratio for developing the second primary tumor for patients with cervical/ upper third, middle third, and lower third esophageal cancer were 0.216, 0.270, and 0.226, respectively. Abstinence of alcohol after diagnosing esophageal cancer, has a lower odds ratio of 0.236, if comparing with those still had the habits of drinking. The patient number and the five-year cumulative survival rate of patients with esophageal cancer only were 33 and 72.9% for stage I, 38 and 59.8% for stage II, 238 and 21.9% for stage III, and 97 and 0% for stage IV. Stratified with the stage of esophageal cancer, the patient number and the five-year cumulative survival rate of patients with esophageal cancer and synchronous secondary primary cancer were 43 and 39.5% for stage I, 20 and 10% for stage II, 37 and 22% for stage III, and 15 and 0% for stage IV, respectively. Conclusion:Age, the location of primary esophageal tumor, and continuous drinking after diagnosis are important predictors of developing second primary tumors in esophageal cancer. For stage I and stage II esophageal cancer patients, there is a great statistical difference of the 5-year survival rate between those with second primary cancer and those without. However, the difference disappears for patients with stage III and IV esophageal cancer. Earlier diagnosis of the second primary cancer and earlier treatment can improve the survival rate of patients.

並列關鍵字

Esophageal cancer ； second primary tumor ； risk factors ； prognostic factors

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases, 40(5), 373-383.

中文文獻