跳到主要內容

臺灣博碩士論文加值系統

(3.231.230.177) 您好!臺灣時間:2021/08/04 05:12
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:吳宗燕
研究生(外文):Tsung-Yen, Wu
論文名稱:影響胃癌病患預後存活的風險因子探討-三十年資料分析
論文名稱(外文):The Risk Factors Affecting Prognosis of Gastric Cancer Patients: Thirty-Year Data Analysis
指導教授:楊長興楊長興引用關係
指導教授(外文):Chiang-Hsing, Yang
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:中文
論文頁數:80
中文關鍵詞:胃癌五年存活率預後因素年代分組period groups
外文關鍵詞:gastric cancerfive year survival rateprognostic factors
相關次數:
  • 被引用被引用:0
  • 點閱點閱:441
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
國立台北護理學院醫護管理研究所碩士論文摘要
背景:胃癌是我國的主要癌症之ㄧ,過去對胃癌的相關研究多以危險因子的探討、胃癌的預防、致病的機轉,或是臨床治療的方法為主,很少使用長期綜合相關預後因素著手,來探討其對病人術後存活的影響。國內外對於胃癌的相關預後因素已經有許多相關的研究支持之,但對於年代變遷之間胃癌病患預後狀況的研究卻不多,本研究將以此議題進一步做探討。
目的:探討影響胃癌病患術後存活之相關因素及30年長期胃癌個案依年代每10年分一組後,年代分組之間術後存活情形的差異。
材料:1974-2003年間臺北市立仁愛醫院確診為胃癌並執行手術治療之1,240位病患的病歷資料。
方法:採用Kaplan-Meier method、log-rank test及Cox proportional hazard model,檢定各年代分組間的存活曲線,並比較不同年代分組間之差異。
結果:胃癌病患之年齡、臨床及病理組織學變項皆為影響胃癌病人術後長期存活的相關因素;依年代分組比較胃癌病患術後五年存活率會有顯著差異;在控制病患相關人口學、臨床資料及病理組織學變項後,1994-2003年的胃癌病患術後五年存活率會較1974-1983年的好,但1974-1983年及1984-1993年兩組則無統計上之顯著差異。
討論:使用多中心比較或是其他輔助療法深入探討,且若能加入更多病患及醫院的資訊,將有助於預估與改善胃癌病患的預後情形,是未來研究值得探究的部分。
限制:部分相關危險因子(家族癌病史及術前疾病史等)遺漏嚴重無法加以分析。
ABSTRACT
Background: Gastric cancer is one of the most common cancers in Taiwan. Pervious studies of gastric cancer had focused on the pathogenesis, risk factors, prevention and treatments of gastric cancer, but few had tried to study the issues caused by long-term comprehensive prognosis factors. Furthermore, many studies had demonstrated the important prognostic factors of gastric cancer, but there were rarely researches about the long-term examinations of operative patients.
Objective: This study aimed to investigate demographic, clinical, pathological variables and period groups associated with survival status of gastric cancer patients.
Data source: From 1974 to 2003, the hospital data of 1,240 gastric cancer patients concerning surgical treatment, pathological diagnosis and outcome were collected.
Methods: Retrospective analysis of the results was made, five year survival rates were calculated by Kaplan-Meier method and univariate analysis and multiple factors comparison were done through Log-rank test and Cox proportional hazard model.
Results: The prognostic factors which affecting gastric cancer patients were age, clinical and pathological variables. Single factor analysis indicated that period group was significantly influential factors for the prognosis of patients. With other prognosis factors being controlled, five year survival rate for the gastric cancer patients undergoing surgeries during 1994 to 2003 was better than that of the gastric cancer patients during 1974 to 1983. However, there was no significance between the group of 1974 to 1983 and 1984 to 1993.
Discussion: Using multi-institutional comparison or studying supportive care may add more information about patients and hospitals which will aid prognosis improvement.
目錄
國立台北護理學院醫護管理研究所碩士論文摘要 I
目錄 III
圖目錄 IV
表目錄 V
第一章 緒論 1
第一節 研究背景 1
第二節 研究重要性 8
第三節 研究目的 9
第四節 研究範圍之界定及限制 10
第二章 文獻探討 11
第一節 胃癌簡介 11
第二節 影響胃癌病人存活一般因素的實證性研究 20
第三節 胃癌臨床病理表現與其預後結果之關係 28
第四節 對本研究的啟示 33
第三章 研究方法 34
第一節 概念性架構 34
第二節 研究假說 37
第三節 資料來源及變項定義 38
第四節 統計分析方法 41
第五節 研究方法小結 44
第四章 研究結果 45
第一節 描述性分析 45
第二節 存活分析及假說檢定 50
第三節 研究結果小結 61
第五章 討論與建議 62
第一節 研究討論 62
第二節 研究限制 66
第三節 建議 67
第四節 結論 69
參考文獻 70
中文部份 70
英文部份 71
參考文獻
中文部份
台大內科(2004)。台大內科學講義第四版。台北,橘井文化。
行政院衛生署統計室(2007)。十大惡性腫瘤申報發生人數及發生率。瀏覽日期:2007年6月20日。網址:http://www.stat.gov.tw/ct.asp?xItem=15433&CtNode=3640
行政院衛生署統計室(2007)。惡性腫瘤申報發生人數按國際疾病分類、年齡、性別分。瀏覽日期:2007年6月20日。網址:http://www.stat.gov.tw/ct.asp?xItem=15433&CtNode=3640
吳明賢(2005)。胃癌。當代醫學,32(2),93-105。
吳明賢、林肇堂、李威傑、游憲章(1994)。本土醫學資料庫之建立及衛生政策上之應用(DOH82-HP- 114-4M16)。行政院衛生署委託研究計畫。
吳明賢、王錦堂、林肇堂(1998)。幽門螺旋桿菌與胃癌。內科學誌,9,107-114。
吳秋文(無日期)。台灣常見的癌症 胃癌。瀏覽日期:2007年5月15日。網址:http://www.canceraway.org.tw/Binformation/know2.php?KnowMain
_ID=15&Which_no=2
吳秋文、王英輝(2006)。胃癌的外科治療現況。聲洋防癌之聲,114,37。
吳秋文、雷永耀、彭芳谷(2000)。胃癌之診斷及治療。台北,九州。
林肇堂(1994)。胃癌之流行病學研究 (DOH83-TD-025)。行政院衛生署委託研究計畫。
柯富聰(2007)。胃癌綜論。北市醫學雜誌,3(6),534-541。
莊喬雄、許博翔(2006)。現代醫學與胃癌的戰爭。科學發展,399,54-61。
陳炯年(2006)。胃癌晶片測存活率準度近8成。瀏覽日期:2007年3月20日。網址:http://www.epochtimes.com/b5/6/5/21/n1325031.htm
陳淑媛、林肇堂、陳建仁(1998)。胃癌之流行病學特徵及危險因子。中華公共衛生雜誌,17(4),275-292。
陶聲洋防癌基金會(2007)。癌別防治 胃癌。瀏覽日期:2007年6月20日。網址:http://www.sydao.org.tw/cure/cancer_16.html
葉啟娟、林明燦(2006)。胃癌。台灣醫學,10(4),468-474。
國家衛生研究院癌症研究組(1999)。胃癌診治共識。台北,臺灣癌症臨床研究合作組織。
癌症登記工作小組(2007)。癌症登記92年度報告。台北,中華民國公共衛生學會。
羅世薰(無日期)。台北榮總腫瘤治療準則之胃癌治療原則。瀏覽日期:2007年3月13日。網址:http://140.122.147.15/~cptc/standard_doc8.php?cg=3


英文部份
Adachi, Y., Mori, M., Maehara, Y., & Sugimachi, K. (1994). Dukes’s classification: A valid prognostic indicator for gastric cancer. Gut, 35, 1368-1371.
Allgayer, H., Heiss, M. M., & Schildberg, F. W. (1997). Prognostic factors in gastric cancer. British Journal of Surgery, 84(12), 1651-1664.
Armitage, P., Berry, G., & Matthews, J. N. S. (2002). Statistical methods in medical research (4th ed.). Oxford: Blackwell Scientific Publications.
Aurello, P., D'Angelo, F., Rossi, S., Bellagamba, R., Cicchini, C., Nigri, G., et al. (2007). Classification of lymph node metastases from gastric cancer: Comparison between N-site and N-number systems. Our experience and review of the literature. American Surgeon, 73 (4), 359-366.
Barchielli, A., Amorosi, A., Balzi, D., Crocetti, E., & Nesi, G. (2001). Long-term prognosis of gastric cancer in a European country: A population-based study in Florence (Italy). 10-year survival of cases diagnosed in 1985-1987. European Journal of Cancer, 37(13), 1674-1680.
Bonenkamp, J. J., Hermans, J., Sasako, M., & Van Develde, C .J. H. (1999). Extended lymph-node dissection for gastric cancer. The New England Journal of Medicine, 340(12), 908-914.
Bonenkamp, J. J., van de Velde, C. J. H., Kampschöer, G. H. M., Hermans, J., Hermanek, P., Bemelmans, M., Gouma, D. J., et al. (1993). Comparison of factors influencing the prognosis of Japanese, German, and Dutch gastric cancer patients. World Journal of Surgery, 17(3), 410-414.
Borie, F., Rigau, V., Fingerhut, A., & Millat, B. (2004). Prognostic factors for early gastric cancer in France: Cox regression analysis of 332 cases. World Journal of Surgery, 28, 686–691.
Bozzetti F, Bonfanti G, Morabito A, Bufalino, R., Menotti, V., Andreola, S., Doci, R., et al. (1986). A multifactorial approach for the prognosis of patients with carcinoma of the stomach after curative resection. Surgery, Gynecology & Obstetrics, 162(3), 229-234.
Bunt, A. M., Hermans, J., Boon, M. C., van de Velde, C. J., Sasako, M., Fleuren, G. J., & Bruijn, J. A. (1994). Evaluation of the extent of lymphadenectomy in a randomized trial of Western- versus Japanese-type surgery in gastric cancer. Journal of Clinical Oncology, 12(2), 417-422.
Coldman, A. J., & Elwood, J. M. (1979). Examining Survival data. Canadian Medical Association Journal, 121(8), 1065-1069.
Crew, K. D., & Neugut, A. I. (2006). Epidemiology of gastric cancer. World Journal of Gastroenterology, 12(3), 354-362.
Cuschieri, A., Weeden, S. Fielding, J., Bancewicz, J., Craven, J., Joypaul,V. Sydes, M., et al. (1999). Patient survival after D1 and D2 resections for gastric cancer: Long-term results of the MRC randomized surgical trial Co-operative Group. British Journal of Cancer, 79, 1522-1530.
Dawson, B., & Trapp, R. (2001). Basic and clinical biostatistics (3rd ed.). New York: McGraw-Hill.
Degiuli, M., Sasako, M., Calgaro, M., Garino, M., Rebecchi, F., Mineccia, M., Scaglione, D., et al. (2004). Morbidity and mortality after D1 and D2 gastrectomy for cancer: Interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. European Journal of Surgical Oncology, 30(3), 303-308.
Doglietto, G. B., Pacelli, F., Caprino, P., Sgadari, A., & Crucitti, F. (2000). Surgery: Independent prognostic factor in curable and far advanced gastric cancer. World Journal of Surgery, 24(4), 459-463.
Furukawa, H., Hiratsuka, M., & Iwanaga, T. (1988). A rational technique for surgical operation on Borrmann type 4 gastric carcinoma: Left upper abdominal evisceration plus Appleby's method. British Journal of Surgery, 75(2), 116-119.
Hartgrink, H. H., van de Velde, C. J. Putter, H., Bonenkamp, J. J., Kranenbarg, E. K., Songun, I., Welvaart, K., et al. (2004). Extended lymph node dissection for gastric cancer: Who may benefit? Final results of the randomized Dutch gastric cancer group trial. Journal of Clinical Oncology, 22(11), 2069-2077.
Hiroaki, S., Tomohiro, O., Daiki, M., Teruhisa, S., Shingo, K., Shotaro, O., Shigeru, T., et al. (2006). Macroscopic tumor size as a simple prognostic indicator in patients with gastric cancer. American Journal of Surgery 192, 296-300.
Hochwald, N. S., Kim, S., Klimstra, S. D., Brennan, F. M., & Karpeh, S. M. (2000). Analysis of 154 actual five-year survivors of gastric cancer. Journal of Gastrointestinal Surgery, 4(5), 520-525.
Hundahl, A. S., Phillips, L. J., & Menck, R. H. (2000). The National Cancer Data Base report on poor survival of U. S. gastric carcinoma patients treated with gastrectomy. Cancer, 88, 921-932.
Jemal, A., Siegel, R., Ward, E., Murray, T., Xu, J., Smigal, C., et al. (2007). Cancer statistics, 2006. Cancer Journal for Clinicians, 56(2), 106-130.
Kamanger, F., Dores, M. G., & Anderson, F. W. (2006). Patterns of cancer incidence, mortality, and prevalence across five continents: Defining priorities to reduce cancer disparities in different geographic regions of the world. Journal of Clinical Oncology, 24, 2137-2150.
Kaplan, E. L., & Meier, P. (1958). Nonparametric estimation from incomplete observations. Journal of American Statistical Association, 53(282), 457-481.
Kim, J. P., Kim, Y. W., Yang, H. K., & Noh, D. Y. (1994). Significant prognostic factors by multivariate analysis of 3926 gastric cancer patients. World Journal of Surgery, 18(6), 872–878.
Kranenbarg, E. K., Hermans, J., van Krieken, J. H. J. M., & van de Velde, C. J. H. (2001). Evaluation of the 5th edition of the TNM classification for gastric cancer: Improved prognostic value. British Journal of Cancer, 84(1), 64-71.
Liu, Y., Kaneko, S., & Sobue, T. (2004). Trends in reported incidences of gastric cancer by tumour location, from 1975 to 1989 in Japan. International Journal of Epidemiology, 33(4), 808-815.
Lo, S. S., Wu, C. W., Chen, J. H., Li, A. F. Y., Hsieh, M. C., Shen, K. H., Lin, H. J., et al. (2007). Surgical results of early gastric cancer and proposing a treatment strategy. Annals of Surgical Oncology, 14(2), 340-347.
Maruyama, K. (1981). Japanese staging system for gastric cancer. Scandinavian Journal of Gastroenterology, 22(133), 22.
Maruyama, K. (1987). The most important prognostic factors for gastric cancer patients: A study using univariate and multivariate analyses. Scandinavian Journal of Gastroenterology, 22(supply), 63-68.
McCulloch, P. (1994). Should general surgeons treat gastric carcinoma? An audit of practice and results, 1980-1985. British Journal of Surgery, 81(3), 417-420.
McCulloch, P., Nita, M. E., Kazi, H., & Gama-Rodrigues, J. (2003). Extended versus limited lymph nodes dissection technique for adenocarcinoma of the stomach. Cochrane Database of Systematic Reviews, 4, 1964-1965.
Moriguchi, S., Maehara, Y., Korenage, D., Sugimachi, K., & Nose, Y. (1993). Relationship between age and the time of surgery and prognosis after gastrectomy for gastric cancer. Journal of Surgical Oncology, 52(2), 119-123.
Msika, S., Benhamiche, A. M., Jouve, J. L., Rat, P., & Faivre, J. (2000). Prognostic factors after curative resection for gastric cancer. A population-based study. European Journal of Cancer, 36(3), 390-396.
Nakamura, K., Ueyama, T., Yao, T., Xuan, Z. X., Ambe, K., Adachi, Y., Yakeishi, Y., et al. (1992). Pathology and prognosis of gastric carcinoma. Findings in 10,000 patient who underwent primary gastrectomy. Cancer, 70, 1030-1037.
Noguchi, Y., Imada, T., Matsumoto, A., Coit, D., & Brennan, M. (1989). Radical surgery for gastric cancer. A review of the Japanese experience. Cancer, 64, 2053-2062.
Petrie, A., & Sabin, C. (2005). 圖解醫學統計學(程慧娟 譯)。台北:合記。(原書發行於2003)
Peto, R., Pike, M. C., & Armitage, P. (1977). Design and analysis of randomized clinical trials requiring prolonged observation of each patient analysis and examples. British Journal of Cancer, 35(1), l-39.
Piso, P., Bektas, H., Werner, U., Becker, T., Aselmann, H., Schlitt, H. J., & Klempnauer, J. (2002). Comparison between treatment results for gastric cancer in younger and elderly patients. Zentralblatt für Chirurgie, 127(4), 270-274.
Piso, P., Werner, U., Benten, D., Bektas, H., Meuer, U., & Klempnauer, J. (2001). Early gastric cancer – excellent prognosis after curative resection in 87 patients irrespective of submucosal infiltration, lymph-node metastases or tumor size. Langenbeck's Archives of Surgery, 386(1), 26-30.
Roder, D. M. (2002). The epidemiology of gastric cancer. Gastric cancer, 5(1), 5-11.
Roder, J. D., Böttcher, K., Busch, R., Wittekind, C., Hermanek, P., & Siewert, J. R. (1998). Classification of regional lymph node metastasis from gastric carcinoma. German gastric Cancer Study Group. Cancer, 82(4), 621-631.
Roy, P., Piard, R., Dusserre-Guion, L., Martin, L., Michiels-Marzais, D., & Faivre, J. (1998). Prognostic comparison of the pathological classifications of gastric cancer: A population-based study. Histopathology, 33(4), 304-310.
Saito, H., Osaki, T., Murakami, D., Sakamoto, T., Kanaji, S., Tatebe, S., Tsujitani, S., et al. (2006). Effect of age on prognosis in patients with gastric cancer. ANZ Journal of Surgery, 76 (6), 458-461.
Sano, T., Sasako, M., Yamamoto, S., Nashimoto, A., Kurita, A., Hiratsuka, M., Tsujinaka, T., et al. (2004). Gastric cancer surgery: Morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group Study 9501. Journal of Clinical Oncology, 22(14), 2767-2773.
Stewart, B. W., & Kleihues, P. (2003). World Cancer Report. Lyon, France: International Agency for Research on Cancer.
Wang, C. S., Hsueh, S., Chao, T. C., Jeng, L. B., Jan, Y. Y., Chen, S. C., Hwang, T. L., et al. (1997). Prognostic study of gastric cancer without serosal invasion: Reevaluation of the definition of early gastric cancer. Journal of the American College of Surgeons, 185(5), 476-480.
Wu, C. W., Hsiung, C., Lo, S. S., Hsieh, M. C., Chen, J. H., Li, F. Y., Lui, W. Y., et al. (2006). Nodal dissection for patients with gastric cancer: A randomized controlled trial. Lancet Oncology, 7, 309-315.
Yamamura, Y., Nakajima, T., Ohta, K., Nashimoto, A., Arai, K., Hiratsuka, M., Sasako, M., et al. (2002). Determining prognostic factors for gastric cancer using the regression tree method. Gastric Cancer, 5(4), 201-207.
Yasui, W., Sentani, K., Motoshita, J., & Nakayama, H. (2006). Molecular pathobiology of gastric cancer. Scandinavian Journal of Surgery, 95(4), 225-231.
Yokota, T., Ishiyama, S., Saito, T., Teshima, S., Narushima, Y., Murata, K., et al. (2004). Lymph node metastasis as a significant prognostic factor in gastric cancer: A multiple logistic regression analysis. Scandinavian Journal of Gastroenterology, 39(4), 380-384.
Yokota, T., Ishiyama, S., Saito, T., Teshima, S., Yamada, Y., Iwamoto, K., et al. (2002). Is tumor size a prognostic indicator for gastric carcinoma? Anticancer Research, 22(6B), 3673-3677.
Yokota, T., Kunii, Y., Saito, T., Teshima, S., Narushima, Y., Yamada, Y., et al. (2000). Lymph node metastasis as a significant prognostic factor in gastric cancer: A multiple logistic regression analysis. Scandinavian Journal of Gastroenterology, 39(4), 380-384(5).
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關論文