臺灣博碩士論文加值系統

男性口咽癌是台灣地區發生率上升最快的癌症，因此本研究的目地為探討男
性口腔癌發生率與環境因子的相關性，利用全國癌症登記資料，使用年齡、年代、世代模式進行男性口腔癌的長期趨勢分析，並且加入環境因子探討(1)彰化與全國其他地區差異(2)彰化地區的地緣分佈 (3)居住地之土壤鎳濃度分區。
本研究結果顯示，控制在相同水準的鄉鎮嚼食檳榔盛行率下，土壤砷、鎳
濃度對於男性口腔癌發生率具有梯度效應；在年齡、年代、世代模型分析結果顯示，彰化與全國的男性口腔癌在近世代的相對危險率較早期世代高，表示在近年來環境某危險因子發生改變。與全國相比，彰化的男性口腔癌相對危險較高，表示彰化暴露在較具風險的環境之下；另外針對彰化地區依地理位置分區，彰化北、中地區較年輕的年齡層與南部地區相比，有較高的口腔癌危險率，而相關研究認為造成彰化地區口腔癌的發生具有地緣差異與工廠密度有關，因此我們懷疑工廠造成的土壤重金屬汙染與口腔癌發生有密不可分的關係；最後探討全國不同土壤鎳濃度分區的男性口腔癌發生率，隨著鎳濃度越高具有越高的危險率，顯示土壤鎳濃度對口腔癌發生率具有相當的影響，是不容忽視的環境因子。我們期望未來能透過患者體內重金屬鎳的累積程度，來釐清重金屬鎳與男性口腔癌的關聯性。

Male oropharyngeal cancer is one of the fastest growing malignancies in Taiwan.The purpose of this study is to explore the correlation between environment factors and incidence rate of male oral cavity cancer. We analyzed the registered records of male oral cavity cancer in Taiwan by using the Age-Period-Cohort model with additional environment factors. The objectives are to study the long term epidemiological difference between (1) Changhua and the rest areas in Taiwan (2) different regionals in Changhua (3) residential areas with different levels of heavy metal concentration in farm soil.
Our results reveal that controlling townships with the same prevalence rate of betel quid chewing, soil arsenic and nickel concentration provided the gradient effect on the incidence rate of male oral cavity cancer. The Age-Period-Cohort model shows that the high relative risk in late birth cohorts to the early birth cohorts, which indicate that some risk factors in our living environment were changed.
To compare with the rest areas in Taiwan, Changhua had higher relative risk of male oral cavity cancer, we may infer that the residents in Changhua expose to higher
risk environment than the others. Besides, we focus on incidence of male oral cavity cancer in Changhua geographic regions, the risk of male oral cavity cancer in the younger age groups among the middle and north regions of Changhua were higher than the south region of Changhua, while related study was on the opinion that the geographically difference in the incidence of male oral cancer in Changhau was related to the density of factories, so we doubts that the incidence of oral cavity cancer is association with the heavy metals in soil which were polluted by factories. As for the region with different levels of heavy metal, we found that the risk was increasing with the soil nickel concentration. Further study is needed to specialty the relation between heavy nickel and male oral cavity cancer by computing the accumulation of nickel in human body.

目錄
中文摘要
英文摘要
第一章 緒論...............................................1

第一節 研究背景...........................................1
第二節 研究動機...........................................2
第三節 研究目的...........................................2

第二章 文獻探討.............................................3

第一節 Age-Period-Cohort模型..............................3
第二節 利用Age-Period-Cohort模型探討口腔癌之相關文獻 ........8
第三節 口腔癌相關危險因子之探討 ........................... 10
第四節 重金屬環境汙染與相關流行病學探討 .................... 13

第三章 材料及方法..........................................16

第一節 資料來源.......................................... 16
第二節 研究流程...........................................18
第三節 統計方法...........................................19

第四章 結果...............................................25

第一節 口腔癌發生率資料相關因子研究.........................25
第二節 口腔癌病例Age-Period-Cohort模型分析.................28

第五章 討論...............................................35
第一節 危險因子與口腔癌發生率之探討........................ 35
第二節 口腔癌年齡、年代、世代效應...........................37

參考文獻..................................................42
圖表.....................................................47
附錄.....................................................89

表1 全國1983-2002 年口腔癌病患年齡、診斷年代、居住地、環境鎳值之分佈分佈47
表2 全國316 鄉鎮男性口腔癌發生率、土壤中重金屬濃度、檳榔盛行率、抽菸盛行率之平均值、第一四分位(Q1)、中位數(Median)、第三四分位(Q3)….48
表3 西部非都市259 鄉鎮男性口腔癌發生率、土壤中重金屬濃度、檳榔盛行率、抽菸盛行率之平均值、第一四分位(Q1)、中位數(Median)、第三四分位(Q3)..….49
表4 全國316 鄉鎮男性口腔癌與土壤中重金屬濃度、男性嚼食檳榔盛行率、男性抽菸盛行率相關係數…………………….…........50
表5 西部非都市259 鄉鎮男性口腔癌與土壤中重金屬濃度、男性嚼食檳榔盛行率、男性抽菸盛行率相關數……………………………………...…..51
表6 全國316 鄉鎮男性口腔癌變異數分析總檢定…………52
表7 全國316 鄉鎮男性口腔癌變異數分析主因子效用檢定表……………52
表8 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行
率鄉鎮之下，不同土壤砷水準鄉鎮之平均發生率……………………..…...53
表9 全國316 鄉鎮男性口腔癌發生率變異數分析成對(pairwise-comparison)顯著性檢定，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤砷水準之平均發生率…….53
表10 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率……………………………………...54
表11 全國316 鄉鎮男性口腔癌發生率變異數分析成對(pairwise-comparison)顯著性檢定，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準之平均發生率…...54
表12 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率……………...55
表13 全國316 鄉鎮男性口腔癌發生率變異數分析成對(pairwise-comparison)顯著性檢定，控制在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準之平均發生率55
表14 西部非都市259 鄉鎮男性口腔癌變異數分析總檢定……………56
表15 西部非都市259 鄉鎮男性口腔癌發生率變異數分析主因子效用檢定表56
表16 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤砷水準鄉鎮之平均發生率……………………57
表17 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤砷水準鄉鎮之平均發生率，成對(pairwise-comparison)顯著性檢定…...57
表18 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率………………...58
表19 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率，成對(pairwise-comparison)顯著性檢定………………………………...58
表20 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準之平均發生率……………………………………59
表21 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準之平均發生率，成對(pairwise-comparison)顯著性檢定59
表22 彰化與全國男性口腔癌APC 模型………………………60
表23 彰化與全國男性口腔癌APC 模型在50-54 歲、1988-1992 年代、1938-1942 世代下(基準組) 各年齡、年代、世代效應與地區比(表22 model 18)61
表24 平均世代效應下，彰化與全國其他地區不同年代與年齡的地區比…62
表25 平均年齡效應下，彰化與全國其他地區不同世代與年代的地區比…63
表26 平均年代效應下，彰化與全國其他地區不同年齡與世代的地區比…64
表27 彰化男性分北中與南兩地區別之APC 模式………………………65
表28 彰化男性分北中與南兩地區之APC 模式中年齡效應之地區比……66
表29 台灣地區男性口腔癌分鎳濃度APC 模型…………………67
表30 台灣地區男性口腔癌分鎳地區APC 模型中(表29 model14)，各地區年齡效應之地區比…………68
表31 鎳濃度分區，暴露年數為0 的族群中，不同世代的男性口腔癌發生率69
表32 鎳濃度分區45-49 歲族群中，不同世代的男性口腔癌發生率………69
圖1 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤砷水準鄉鎮之平均發生率…………….70
圖2 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率…………………...70
圖3 全國316 鄉鎮男性口腔癌發生率變異數分析，控制在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率…………………………………71
圖4 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤砷水準鄉鎮之平均發生率…………………72
圖5 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同嚼食檳榔盛行率鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率…………………..72
圖6 西部非都市259 鄉鎮男性口腔癌發生率變異數分析，控制在相同土壤砷濃度鄉鎮之下，不同土壤鎳水準鄉鎮之平均發生率…………………………73
圖7 全國男性口腔癌各年代之年齡別發生率…………………………74
圖8 全國男性口腔癌各出生世代之年齡別發生率………………………74
圖9 彰化男性口腔癌各年代之年齡別發生率……………………………75
圖10 彰化男性口腔癌各出生世代之年齡別發生率………………………75
圖11 平均世代效應下不同年代組彰化與全國其他地區之年齡效應變化76
圖12 平均世代效應下不同年齡組彰化與全國其他地區之年代效應變化77
圖13 平均年齡效應下不同世代組彰化與全國其他地區之年代效應變化78
圖14 平均年齡效應下不同年代組彰化與全國其他地區之世代效應變化79
圖15 平均年代效應下不同世代組彰化與全國其他地區之年齡效應變化80
圖16 平均年代效應下不同年齡組彰化與全國之世代效應變化………81
圖17 彰化男性分北中與南兩地區別之APC 模式(表27model12)………82
圖18 台灣地區男性口腔癌分鎳地區APC 模型(表29 model14)，不同世代組在1988-1992年代時(基準年代組)之年齡效應………………………….83
圖19 台灣地區男性口腔癌分鎳地區APC 模型(表29model14)，不同土壤鎳水準地區在1988-1992 年代及1938-1942 世代時之年齡效應………………84
圖20 利用表29 model14 之估計參數預測不同鎳濃度地區在晚期世代組各年齡層與基準組比較之相對危險…85
圖21 彰化與全國45-49 歲族群中，不同世代的男性口腔癌發生率……86
圖22 鎳濃度分區，暴露年份為0 的族群中，不同世代的男性口腔癌發生率87
圖23 鎳濃度分區45-49 歲族群中，不同世代的男性口腔癌發生率88

附錄一 台灣地區男性口咽癌年齡標準化發生率，按地區分類………89
附錄二 彰化地區地理分區……………………….90
附錄三 台灣男性每十萬人之死亡人數………………91
附錄四 台灣男性口腔癌APC 模型資料值………………92
附錄五 台灣地區膀胱癌各出生世代之年齡別發生率…93

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