- 學位論文
頰癌患者之存活分析與其影響因素－以中部某醫學中心為例
Survival Analysis of Buccal Cancer and its Affecting Factors in a Medical Center of Central Taiwan
摘要
背景： 口腔癌為國人十大癌症之一，台灣男性排名癌症標準化死亡率已高居第四位；針對世界各地頰癌的發生率及比例，近年來死亡率有逐年上升的情形。 研究目的： 瞭解頰癌病患接受治療後影響存活率之相關因素及半年、一年、 一年半、二年、二年半、三年之存活率。 研究方法： 本研究是回溯性探討中部某醫學中心口腔顎面外科部1999-2006年間病理切片檢查診斷為頰癌的317位病患，以確定存活率之相關因素。問卷記錄內容包括性別、年齡、腫瘤大小、頸部淋巴轉移、遠端器官轉移、臨床分期、組織分化程度、口腔習慣(菸、酒、檳榔)、手術治療、放射線治療、化學治療。 結果： 男性有309人，佔97.5%；女性有8 人， 佔2.5%，男女性別比高達38.63：1，男性平均發病年齡為52.8歲，女性平均發病年齡為60.5歲。由Kaplan-Meier Analysis 和 Log-Rank Test中發現有8個會影響存活率的變項在統計上有顯著性差異(P<0.05)，分別有腫瘤大小、頸部淋巴轉移、臨床分期、組織分化程度、頸部廓清術、化學治療、放射線治療、合併療法。依Proportional Hazard Model 分析，發現以臨床分期及治療種類方式具有真正影響頰癌病患存活率。本研究發現復發率為11.6%，遠端器官轉移率為8.8%。從「臨床分期」對存活率的影響來看，臨床分期愈不嚴重其存活率愈高，一年存活率分別是第一期86.9%、第二期85.2%、第三期79.7%及第四期89.8%。二年存活率分別為第一期75.0%、第二期73.5%、第三期70.0%及第四期59.3%。三年存活率分別為第一期62.6%、第二期56.3%、第三期59.0及第四期39.8%。；從「治療種類」對存活率的影響來看，可發現手術治療一年、二年、三年存活率分別是80.1%、65.0%、47.5%。頰癌病患每半年存活率差值，接受治療後無論其臨床分期或治療方式半年內存活率皆高，第一高峰危險期是半年至一年，第二高峰危險期是一年至一年半，而接受治療一年半以後的存活率差值有較穩定的趨勢。 結論: 頰癌病患接受治療後半年至一年半是死亡高峰期，這段期間患者需密集追蹤，一年半以後存活率則趨向穩定。
關鍵字
頰癌、存活率、社會人口學因素並列摘要
Background： Oral Cancer has been one of the top ten cancer diseases in Taiwan. It has become the fourth common cancer found especially in men. Moreover, the mortality rate of buccal cancer is rising higher yearly . Study objective： The purpose of this buccal cancer study was to determine the factors which affect to survival rate and the survival rate after 0.5-year ，1-year,1.5-year,2-year,2.5-year and 3-year treatments. Methods： We retrospectively analyzed the records of 317 buccal cancer cases which were collected from 1 January 1999 to 31 December 2006 at Taichung some Medical Center Hospital. The following factors were analyzed: the patient survival of 0.5 -year,1-year,1.5-year,2-year,2.5-year and 3-year treatments, and their age, gender, Tumor site, lymph node involvement, presence of distant metastasis, cancer stage, histological differentiation, operation, chemotherapy, radiotherapy, and some risk factors, such as betel quid chewing, cigarette smoking, and alcohol consumption. Results： Men made up 97.5% of those patients (309 patients), and only 2.5% of them were women (8 patients). The male to female rate was to 38.63:1. The average age of male patients was 52.8 years old, and 60.5 years old for female patients. Kaplan-Meier Analysis and with Log -Rank Test to were used investigate all the related diagnosis and treatment records, We can find out eight variables were found to significantly affect survival: tumor size, lymph node involvement, cancer stage, histological differentiation, lymph node dissection, chemotherapy, treat ment methods, oral habits (all p<0.05,Kaplan-Meier analysis with log-rank test). According to the analysis of Proportional Hazard Model , there are two main factors that affect the survival rate of buccal cancer patients. These two factors are clinical stage and treatment methods , This study found that recurrence rate is 11.6% and the distant metastasis rate is 8.8%. From the point of view of the clinical period, the less serious of the clinical period, the higher the survival rate. The recurrent rate of this study was 11.4%. The 1-year survival was 86.9%、85.2%、79.7%,and 89.8% for patients with stageⅠ,Ⅱ,Ⅲ,Ⅳ. The 2-year survival was 75.0%、73.5%、70.0% and 59.3% for patients with stageⅠ,Ⅱ,Ⅲ,Ⅳ.The 3-year survival was 62.6%、56.3%、59.0%,39.8% for patients with stageⅠ,Ⅱ,Ⅲ,Ⅳ. On the other hand, from the point of treatment methods, the survival was 80.1%、65.0%、47.5% for patients with operations. If the patients are under treatments, the survival rate is highest within the first half year, no matter of their clinical period or treatment methods .The first dangerous period is between the first half and first year. The second dangerous period is between the first year and the second and half years. And the tendency of death after the one and a half year is getting stable. Conclusion: The highest death rate of buccal cancer patient is after half to 1.5 years therapy. Therefore, it’s necessary to track the follow-up intensively. The survival rate is getting stable after one and a half year therapy.