臺灣博碩士論文加值系統

目標:探討新發結直腸癌世代合併有共病症疾病之潛在類別組別及對其術後一年死亡的影響。

方法:採回溯性世代研究法，研究對象為2000年至2009年新診斷結直腸癌病患(N = 15,854)，潛在類別分析病患初次診斷前一年共病症潛在類別分組。邏輯思迴歸分析潛在類別組別對其術後一年死亡之影響。

結果:經潛在類別分析，兩性共病症各產生些微不同的五組最佳模式。性別分層發現在控制其他變項情況下，男性初次診斷前一年合併有「以腦血管為核心」、「以慢性肺部疾病為核心」比合併有「以消化性潰瘍為核心」之死亡風險高出1.25倍(95% CI [1.05, 1.50]）及1.27倍(95% CI [1.07, 1.50]）。 女性初次診斷前一年合併有「以失智症為核心」、「以腦血管為核心」比合併有「以消化性潰瘍為核心」之死亡風險高出1.68倍(95% CI [1.19, 2.38])及1.28 倍(95% CI [1.01, 1.62])。

結論:合併多重共病症經潛在類別分析產生五組最佳模式。不同性別及不同共病症疾病組別對其術後一年死亡風險有不同程度的影響。結果可提供專業醫療人員早期發現早期提供治療或預防。衛生政策單位可依據結果針對風險較高的共病症建立衛生教育或治療指引，以降低癌症病患的死亡風險。

Objective: To explore the latent classification of comorbidity and evaluate the influence of latent classes on the one-year mortality of colorectal cancer patients after surgery.

Methods : The retrospective cohort study included patients with at lease one comorbidity before the newly diagnosed of colorectal cancer from 2000 to 2009(N=15,854). The latent classification analysis was used to identify the latent clases of comobidity. The logistic regression analysis was used to evaluate the influence of latent classes on the one year mortality.

Results: Latent class analysis indicated most suitable 5 subgroups, and mild differences were found between two genders. For male, comparing patients with peptic ulcer comobidity, patients with cerebrovascular and chronic pulmonary comorbidity had higher risk of mortality (OR= 1.25, 95% CI [1.05, 1.50]; OR= 1.27, 95% CI [1.07, 1.50], respectively). For women, comparing patient with peptic ulcer comobidity, patients with cerebrovascular and dementia comorbidity had higher risk of mortality (OR= 1.28, 95% CI [1.01, 1.62]; OR=1.68, 95% CI [1.19, 2.38], respectively).

Conclusion: Identifying comobidities into 5 subgroups were best models for latent class analysis. One-year mortality after surgery depends on genders and different comobidity subgroups. These results can be useful to medical teams to take proper prevention and treatment. Health policy maker can establish the guideline of health education and treatment for those patients with risky comorbidity to early reduce the risk of mortality on cancner patients.

目錄 III
表次 IV
圖次 V
第一章諸論 1
第一節研究背景與動機 1
第二節問題陳述 1
第三節研究目的與研究問題 3
第四節研究之重要性 3
第二章文獻探討 4
第一節世界各國罹患結直腸癌之流行病學 5
第二節共病症疾病對結直腸癌術後之影響 17
第三節其它影響結直腸癌術後死亡的危險因子 26
第四節潛在類別分析（Latent Class Analysis, LCA）方法之優勢 34
第三章研究方法 38
第一節研究架構 38
第二節 研究設計 39
第三節 研究對象 39
第四節研究資料來源與變項操作行定義 42
第五節 研究資料處理過程 53
第六節統計方法 57
第四章研究結果 59
第一節研究對象之特性 59
第二節共病症疾病潛在分類 60
第三節結直腸癌病患術後一年死亡之相關因素 64
第四節共病症疾病潛在類別組別對於病患術後一年死亡之影響 68
第五章討論與建議 88
第一節研究結論與討論 88
第二節為本研究之優點、限制與建議 95
第三節為研究結果之應用 97
參考文獻 99
中文部分 99
英文部分 101
附錄A 107
共病症疾病ICD-9-CM代碼 107

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