臺灣博碩士論文加值系統

肺癌早期症狀不明顯，就醫診斷時有80%的病患進入末期，使治療效果不彰、存活率差，肺癌病患相較於一般群體的5年相對存活率僅11%-23%。美國國家癌症研究所發現，癌症診斷外若有嚴重共病症(comorbidity)存在，使癌症死亡率增加，而在所有癌症中，肺癌出現共病症的比例是最高的。
其他國家對於肺癌存活率已有重大發現，但台灣則較少針對共病症與肺癌存活率以及肺癌相對存活率來研究，因此本篇論文將從台灣全民健保資料庫「肺癌病人歸人檔」篩選肺癌診斷在2003-2013年間的病患來進行兩部分研究。
第一部分，分析肺癌診斷前1年及前3年內的共病症與肺癌存活率的關係，研究結果發現無共病症的病人5年存活率為11.8%-23.7%、重度共病症為6.8%-13.0%，重度共病症的病人比無共病症的病人5年風險程度(hazard ratio, HR)高出1.20倍，顯示共病症越嚴重，肺癌存活率越差(p < .001)。
第二部分，為了比較肺癌病患相較於一般群體的存活率，且為了篩選出能代表全台灣人健康狀態的一般群體，基於全民健保納保率已達99%以上，故從全民健保資料庫「承保抽樣歸人檔」中以隨機抽樣方式篩選出足以代表台灣母群體的一般群體，之後再依照肺癌病人的性別及年齡來配對一般群體，避免肺癌存活率受到年齡及性別的影響，最後將一般群體的存活率作為分母，肺癌病人的存活率作為分子，計算肺癌5年相對存活率(relative survival)。研究結果發現隨著追蹤年份增加，肺癌5年相對存活率有上升趨勢，從13.1%增加為24.4%，其中以女生及70歲以上的肺癌病人增加幅度最大，此結果可能與醫療進步有相關。
本篇研究目的是希望能對未來台灣肺癌預防、診斷及治療提供更好的指引，以改善肺癌的存活率。

Early lung cancer is mostly asymptomatic. Around 80% of patients with lung cancer have advanced stage, resulting ineffective treatment and poorer survival. Compared to general population, the 5-year relative survival for lung cancer is only 11%-23%. According to American National Cancer Institute report, patients with severe comorbidities at the time of cancer diagnosis increased mortality rate. Comorbidity is the most common among lung cancer patients than other cancers.
There is not much study on comorbidity and lung cancer in Taiwan. Thus, in this thesis, we will examine lung cancer patients diagnosed from 2003 to 2013 in Taiwan through National Health Insurance Research Database (NHIRD).
First, we will observe the relationship between lung cancer survival and comorbidity within 1 and 3 year preceeding the date of lung cancer diagnosis. Our study found that the 5-year survival for the patients with no comorbidity are 11.8%-23.7%, while the patients with high level comorbidity are 6.8%-13.0%. The results indicated that the higher level of comorbidity, the poorer survival for lung cancer (p < .001).
Second, in order to compute the lung cancer relative survival, we randomly sampled general population from NHIRD to represent Taiwanese. The two groups from lung cancer patients and general population were matched for age and gender respectively, then the 5-year relative survival, i.e. ratio of survival for lung cancer patients to the survival of a comparable group of general population was estimated. The results showed that the 5-year relative survival increased from 13.1% to 24.4% across all calendar periods, especially for women and older people.

中文摘要 I
Abstract II
誌謝 III
目錄 IV
表目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 研究動機 1
第二節 研究目標 3
第二章 文獻探討 4
第一節 國內外肺癌流行病學 4
2.1.1 肺癌發生率 4
2.1.2 肺癌種類及病因 4
2.1.3 肺癌篩檢與治療 5
2.1.4 肺癌死亡率及存活率 6
第二節 肺癌與共病症相關性 7
2.2.1 共病症定義 7
2.2.2 共病症與癌症相關性 7
2.2.3 共病症與肺癌相關性 8
2.2.4 共病症嚴重程度評估工具(Charlson comorbidity index, CCI) 9
第三章 研究方法 11
第一節 資料庫來源 11
第二節 研究對象 13
第三節 共病症判定方法 16
第四節 追蹤研究對象最後狀態 18
第五節 統計方法 18
第四章 研究結果 20
第一節 描述性統計 20
第二節 肺癌初診年份、年齡、性別與肺癌存活分析 24
第三節 共病症與肺癌之存活分析 27
第四節 肺癌病人相較於一般群體一年及五年相對存活分析 29
第五章 討論 31
第一節 變數分佈 31
第二節 肺癌存活分析 34
第六章 研究限制與結論 35
第一節 研究限制 35
第二節 結論 36
附錄 37
文獻參考 49

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