子宮頸癌患者五年預後狀況以及醫療資源耗用之相關因素探討

背景：根據世界衛生組織( World Health Organization, WHO)資料顯示，子宮頸癌為女性主要罹患癌症種類第二名。因為台灣健保提供三十歲以上婦女每年一次免費子宮頸抹片篩檢，如發現抹片結果異常，則能盡早接受治療，使病況不會惡化成為子宮頸癌。因此根據國民健康局統計資料顯示，罹患子宮頸癌人數自民國85年有2,942人下降至民國100年1,673人。又衛生福利部民國102年死亡統計年報資料子宮頸癌死亡率於民國85年約10.5人/每十萬人口至民國102年約4人/每十萬人口，在罹患人數與死亡率皆有下降之趨勢。但根據國民健康局民國101年癌症登記年度報告中子宮頸癌仍排名女性死亡因素中第七名，對於患者是否定期接受抹片檢查及其確診時之病狀嚴重度皆有相關。目的：藉由健保資料庫以長期追蹤的方式探討了解新發子宮頸癌患者五年內之各項因素對於癌症復發、住院死亡率與醫療資源耗用。研究方法：本研究使用健保資料庫NHIRD 2010版百萬人承保抽樣歸人檔資料，選取2004-2008年之子宮頸癌病患，於2003年-2004年預留一年時間(Lead time)以便確認病患於2004年之前尚未罹患子宮頸癌，排除不符合本研究的對象後，每位病患追蹤5年。本研究用SAS9.4版進行描述性及推論性統計，描述性以平均數及標準差、樣本數與百分比呈現，推論性統計則使用Linear multiple regression、Cox proportional hazards model進行檢定，以探討不同自變項對於子宮頸癌存活率及醫療資源耗用之影響。結果及結論：本研究比較發現在五年追蹤期間內仍存活之病患，其第一次治療方式以手術治療較多(108人)、診斷前之年平均婦產科門診次數較多(4.41 ± 4.38次)、診斷前之平均子宮頸抹片篩檢次數較少(1.58 ± 1.23次)、疾病嚴重度較低(1.87 ± 1.03分)、五年醫療費用較少(490,432.50 ± 435,811.93元)。而在五年內死亡之病患，其第一次治療方式以放射治療較多(8人) 、診斷前之年平均婦產科門診次數較少(2.89 ± 1.45次)、診斷前之平均子宮頸抹片篩檢次數較多(1.89 ± 1.17次)、疾病嚴重度較高(2.67 ± 1.66分) 、五年醫療費用較多(1,413,381.67 ± 707,456.55元)且有顯著性差異(P<0.0001)。此外，對於癌症復發之五年醫療費用亦有顯著性差異(P=0.0426)。因此五年內仍存活之病患，可以推論其定期做抹片篩檢，一但發現罹患子宮頸癌就立即治療，大多以手術治療為主，不僅醫療費用花費較少，且存活時間較長。而五年內死亡之病患，當發現病狀時已經比較嚴重，不僅在治療時程上及醫療費用上都增加不少。

關鍵字

子宮頸癌；子宮頸抹片檢查；子宮頸癌治療；癌症復發；住院死亡率；醫療資源耗用

並列摘要

Background: According to the report of World Health Organization (WHO), cervical cancer is the second leading type of cancers for women. Taiwan NHI provides the free Pap smear screening for over 30-years old women once yearly in order to early treatment. As a result, the amount of cervical cancer patients decreases from 2,942 (1996) to 1,673 (2001) in Taiwan. The cervical mortality rates decrease from 10.5 per hundred thousand females (1996) to 4 per hundred thousand females (2003). However, the HPA annual Report of cancer registration in 2002 has reported cervical cancer is the seventh of the death factors for women. Therefore, the patients with regular Pap tests and symptoms at diagnosis of the severity are related. Purpose: Based on NHI database, studying the duration of cancer recurrence, hospital mortality and medical resource consumption of cervical cancer patients. Method: This study used NHI database 2010 version which select cervical cancer patient from 2004 to 2008. Every entry was followed up for 5 years. SAS 9.4 were used for analysis. Conlusion: This study demonstrated that the patients who accepted the surgery treatment (n=108) were still alive within five year tracking records.. The annual average number of maternity clinics before diagnosis was 4.41 ± 4.38. The annual average number of pap smear test was 1.58 ± 1.23. The severity of illness was 1.87 ± 1.03. The total cost of hospitalization was NTD490,432.50 ± 435,811.93. On the other hand, the patients who dead within five year tracking record, are accepted the radiation treatment (n=8). The annual average number of maternity clinics before diagnosis was 2.89 ± 1.45. The annual average number of pap smear test was 1.89 ± 1.17. The severity of illness was 2.67 ± 1.66. The total cost of hospitalization was NTD490,432.50 ± 435,811.93 and had dramatically divergences (P<0.0001). The total cost of hospitalization for cancer recurrence was also dramatically divergences (P=0.0426). In this study, we conjectured taking pap smear test regularly benefits the survival rate of cervical cancer patients with five year tracking duration. So that they can get treatment immediately, and the treatment outcome will be better when suffering cervical cancer in the early stage. About the patients who dead with first five years, it will be more difficult to treat and cost more due to the late stage of cervical cancer.