Title

結直腸癌手術病人接受輔助性化學治療成效探討

Translated Titles

Colorectal cancer surgery patients received adjuvant chemotherapy investigate the effectiveness

Authors

黃憶如

Key Words

結直腸癌 ; 輔助性化學治療 ; 療效 ; Colorectal cancer ; adjuvant chemotherapy ; efficacy

PublicationName

高雄醫學大學醫務管理暨醫療資訊學系碩士在職專班學位論文

Volume or Term/Year and Month of Publication

2015年

Academic Degree Category

碩士

Advisor

李易蓁

Content Language

繁體中文

Chinese Abstract

研究背景與目的 結腸直腸癌(colorectal cancer, CRC)是世界上最常見的癌症之一,占全球癌症發生率的9%,國內早期發現的比率只有10%,35%在發現罹患癌症時已經轉移。而癌症的治療方法日新月異,隨著醫療科技和技術進步,更需去探討大量的人力、物力投入所產生之醫療耗用,是否對於結腸直腸癌病人的預後有達預期效果。本研究目的主要探討結腸直腸癌手術病人接受化學治療有無,其人口學、癌症特質和治療特質情形、不同化學治療模式對復發、整體存活之影響、有無接受化學治療對醫療資源耗用之影響、化學治療完整性與否對復發、整體存活及醫療資源耗用之影響。 研究方法 本研究為一回溯性研究。收案對象為南部某家醫學中心,2005年1月至2011年12月31日止在個案醫院確診為原發性結直腸癌(ICD_9_CODE:153-154)之病人,並接受初次結直腸腫瘤切除手術的病人為樣本。研究資料來源有病歷審查、該醫院住院醫療費用申報檔、行政院衛服部資料庫死亡檔、該醫院之癌登資料檔。利用SPSS 20.0統計軟體,以獨立樣本T檢定、單因子變異數分析、卡方檢定、COX 比例風險回歸、線性迴歸分析、邏輯迴歸進行資料分析。 研究結果 結腸直腸癌病人平均手術年齡為64.89歲、當次住院天數平均17.64±9.9天,當次醫療費用161,101±97,340元,術後輔助性化療有68%發生復發比例高於未復發病人、AJCC 分期第Ⅲ期復發的機會是第0~Ⅰ期的3.88倍(OR:3.88,95 %CI=1.66~9.07)。有神經周邊侵犯復發的機會是無神經周邊侵犯的1.68倍(OR:1.68,95 %CI=1.14~2.47)。相較於接受輔助性化學治療後死亡情形,手術年齡≧75歲病人是<65歲的1.77倍(OR:1.77,95 %CI=1.26~2.50)。AJCC分期第Ⅲ期死亡風險是第0~Ⅰ期的1.75倍(OR:1.75,95 %CI=1.02~3.01)。醫療資源利用部分,AJCC 分期、淋巴結侵犯有顯著差異(P<0.001、P=0.003),AJCC 分期愈差則醫療費用花費愈多。而AJCC分期第Ⅲ期在術後接受完整之輔助性化學治療有57.0%,高於第Ⅱ期的39.1%,注射型化療藥物於在術後接受完整之輔助性化學治療比例佔61.2%高於口服型的38.8%,有神經周邊侵犯病人的復發機會是無神經周邊侵犯病人的2.60倍(OR:2.60,95 %CI=1.22~5.52)。有達化療完整性病人復發的機會是未達化療完整性病人的5.10倍(OR:5.10,95 %CI=1.37~19.01)。有復發病人接受完整性輔助性化學治療後死亡風險是無復發的11.94倍(HR=11.94,95 %CI=6.43~22.18)(P <0.001)。 結論與建議 AJCC分期愈差,則復發及死亡風險愈高,相對的,醫療資源花費也越多,以存活和醫療資源利用情形來看,早期檢查、早期發現為重要的預防政策。然而,有接受完整性化學治療病人之復發及死亡風險竟然皆高於未完整治療者,值得後續之研究。 關鍵詞 結直腸癌、輔助性化學治療、療效

English Abstract

Background and Purpose Colorectal cancer (colorectal cancer, CRC) is one of the world's most common cancer, accounting for 9% of global cancer incidence, the rate of early detection of domestic only 10%, 35% found cancer has been transferred. The cancer treatment advances, along with advances in medical technology and techniques, but also need to explore a lot of medical manpower, material resources arising from consumption, whether for the prognosis of colorectal cancer patients have reached the desired effect. This study focuses on surgery for colorectal cancer patients receiving chemotherapy with or without its demography, cancer characteristics and treatment characteristics of the case, to relapse, the overall survival of the effects of different chemical treatment mode, with or without receiving effects of chemical treatment on the consumption of medical resources, chemotherapy integrity or not to relapse, overall survival and consumption of medical resources affected. Methods This study is a retrospective study. Received a text object for the southern medical centers, ending January 2005 to December 2011 31 at the hospital diagnosed cases primary colorectal cancer (ICD_9_CODE: 153-154) of the patient, and accept the initial colorectal resection surgery patients as a sample. Research Sources have medical record review, the hospital medical expenses declaration stalls, Executive Yuan Wei Hattori death database files, the hospital's cancer registration profile. Use SPSS 20.0 statistical software for independent samples T test, one-way analysis of variance, chi-square test, COX proportional hazards regression, linear regression analysis, logistic regression data analysis. Results The average age at surgery for colorectal cancer patients was 64.89 years, while the number of times the average hospital stay 17.64 ± 9.9 days, and when the second medical costs 161,101 ± 97,340 yuan, postoperative adjuvant chemotherapy recurrence ratio is higher than 68% of patients without recurrence, AJCC staging first Ⅲ chance of recurrence are 0 ~Ⅰ period of 3.88 times (OR: 3.88,95% CI = 1.66 ~ 9.07). Have the opportunity to peripheral nerve recurrent violations are no violations of the peripheral nerve 1.68 times (OR: 1.68,95% CI = 1.14 ~ 2.47). Compared to receive adjuvant chemotherapy after death situations, surgery patients aged ≧ 75 years is <65 years of 1.77 times (OR: 1.77,95% CI = 1.26 ~ 2.50). AJCC staging of the first Ⅲ risk of death is the first 0 ~Ⅰ of 1.75 times (OR: 1.75,95% CI = 1.02 ~ 3.01). Using part of medical resources, AJCC stage, lymph node involvement have significant differences (P <0.001, P = 0.003), AJCC staging worse then spend the more medical costs. The AJCC staging of the first Ⅲ complete acceptance of postoperative adjuvant chemotherapy had 57.0%, 39.1% higher than the first phase Ⅱ, and injectable chemotherapy drugs after surgery to receive a complete of adjuvant chemotherapy is higher than the proportion of 61.2% oral type 38.8% chance of a relapse of patients with neurological surrounding violations is no violation of the patient's peripheral nerve 2.60 times (OR: 2.60,95% CI = 1.22 ~ 5.52). There are opportunities for the integrity of chemotherapy in patients with chemotherapy relapse is less than 5.10 times the integrity of the patient (OR: 5.10,95% CI = 1.37 ~ 19.01). Relapse after patients received adjuvant chemotherapy integrity risk of death is no recurrence of 11.94 times (HR = 11.94,95% CI = 6.43 ~ 22.18) (P <0.001). Conclusions and Recommendations AJCC staging worse, the higher the risk of recurrence and death, relative, medical resources to spend more also to the survival and health care resource use case view, early detection, early detection is an important preventive policies. However, acceptance of the integrity of the chemical treatment the patient's risk of recurrence and death are even higher than those who did not complete treatment, follow-up study of worth. Keyword:Colorectal cancer, adjuvant chemotherapy, efficacy

Topic Category 醫藥衛生 > 醫院管理與醫事行政
健康科學院 > 醫務管理暨醫療資訊學系碩士在職專班
社會科學 > 管理學
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