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  • 學位論文

口腔癌病患治療後之復發轉移與存活之探討-以中部某醫學中心為例

Exploring the Recurrence Metastasis and Survival after Treatment in Oral Cancer Patients : For Example of a Medical Center in Central Taiwan

指導教授 : 陳淑賢
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摘要


研究目的:本研究以探討口腔癌病患治療後之復發轉移與存活之相關因子為研究目的,分析其預後與存活率之差異,並針對治療方式不同的病患進行效益分析,提供醫療專業人員隨著口腔癌病患的疾病特徵給予參考,進一步改善口腔癌之診療品質提升。 材料與方法:研究對象為中部某醫學中心自2000年4月至2010年8月年間,利用國際疾病分類碼ICD-10抽取有臨床記錄及進行病理切片檢查之口腔癌病患,結果共計898位進入本研究之分析。研究採病歷回溯性分析,收集資料為病患基本資料、個人嗜好、個人其他疾病、腫瘤相關病徵及病患治療後狀態五大部份。統計分析利用描述性統計其人口分布與所佔比率、卡方檢定分析病患之復發轉移與存活狀態之相關性、單因子變異數分析病患影響復發轉移與存活狀態之差異,並以Kaplan-Meier之存活分析及Log-Rank 檢定描繪其存活曲線並估算病患之五年存活率與口腔癌病患存活之關係。 研究結果:本研究男性佔絕大多數(842位,93.8%),女性僅有56位(6.2%),男女性別比為15.13:1,平均年齡為51.95歲。有60.1%的病患有抽菸、喝酒及嚼食檳榔的嗜好;診斷部位以頰黏膜33.1%及舌部27.8%最多;腫瘤期別以第四期最多,佔41.6%;整體復發率為38.1%、轉移率為11%;治療方式以全手術治療之存活率最高。由Kaplan-Meier分析整體5年存活率為46.8%,以Log-Rank檢定發現6項危險因子最具影響存活率,分別為腫瘤期別、腫瘤大小、組織分化程度、頸部淋巴廓清術、淋巴結轉移顆數及治療方式。 結論:本研究針對 898 例口腔癌患者進行回溯性分析,發現治療方式及頸部淋巴廓清術與復發轉移及存活率上有明顯相關性,外科手術為治療口腔癌最主要的選擇,除了臨床照護之外,未來將針對病患之生理與心理層面作進一步之研究,以作為臨床醫師照護病患之參考。

關鍵字

口腔癌 復發 轉移 存活分析

並列摘要


Purpose: This study aims to explore the recurrence metastasis and survival after treatment in oral cancer patients of a Medical center in central Taiwan. Analysis of prognosis and survival differences. In addition, for patients with different treatment effectiveness analysis and further improve the quality of oral cancer clinics improved. Methods: Object of study was obtained from april 2000 to August 2010 of medical center in the central Taiwan. Use of ICD-10 of International Classification of Diseases code, extract have clinical records and pathological biopsy of oral cancer patients, there were 898 patients chosen for the final analyses. Study chart records were retrospectively reviewed, include sociodemographic, personal habits, personal disease, cancer-related symptoms and patient status after treatment. Statistical methods used Descriptive statistics of population distribution and the percentage, Chi-square test analysis of the correlation in patient of recurrence metastasis and survival status, One-way ANOVA analysis of the differences in patient impact of recurrence metastasis and survival status, Kaplan-Meier survival analysis and Log-Rank test depict the survival curve and estimate the five-year survival rate and the relationship between survival of oral cancer patients. Results: In this study, 898 patients were male (N=842,93.8%) and 56 were female (6.2%); the male-to-female ratio was 15.13: 1. The mean age at diagnosis was 51.95 year old. Most of the 60.1% patients had smoking, drinking and betel nut chewing habits; Buccal mucosa (33.1%) and tongue (27.8%) were the most common locations of involvement. The most common stage was stage IV (41.6%);The overall recurrence rate was 38.1%, metastasis rate was 11%; Treatment of the survival highest In the whole surgical. Using Kaplan-Meier survival Analysis, the overall 5-year survival rate was 46.8%. According to the Log-Rank Test, we found the most important factors that correlated to survival were:tumor stage, tumor size, degree of differentiation, lymph node dissection, lymph node metastasis number , treatment.    Conclusion: This study retrospectively reviewed 898 oral cancer patients and found that treatment and lymph node dissection have a significant correlation with recurrence, metastasis and survival rate. Although surgery is the gold standard for oral cancer treatment, further investigation with a prospective cohort study is needed to further clarify the relationship between physical and psychological factors and the survival of oral cancer patients.

並列關鍵字

Metastasis Survival analysis Oral cancer Recurrence

參考文獻


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