臺灣博碩士論文加值系統

研究目的: 利用絕對與相對指標按不同年代及年齡層進行肺腺癌發生率的性別比較。
研究方法: 資料來源自世界衛生組織(World Health Organization, WHO)的國際癌症研究機構(International Agency for Research on Cancer, IARC)出版的 Cancer Incidence in Five Continents 第六至第八版、台灣行政院衛生署癌症登計系統提供肺腺癌的發生資料，共18個國家。分析年代有1983-1987年和1993-1997年。計算肺腺癌直接年齡標準化發生率與年齡別(30-44、45-64、65-79)發生率，及分析不同年齡層、不同年代之肺腺癌發生率之年齡與年代增加率，進一步利用Poisson 迴歸計算相對危險性及其95%信賴區間(95% confident interval, 95%CI)。
結果: 1983-1987年台灣肺腺癌年齡標準化發生率男性每十萬人口為4.94人、女性3.05人， 1993-1997年男女性分別為8.27人、6.52人，其餘國家除了冰島外都呈現男性肺腺癌發生率高於女性，且大多數國家性別比隨年代增加而下降。以30-44歲當做基線(baseline)，在1983-1987年於45-64歲台灣男性肺腺癌發生率之年齡增加率為965.12%、女性622.31%，65-79歲男女性分別為2468.22%、1279.34%，除了1983-1987年的印度和西班牙外，其餘國家皆為男性年代增加率高於女性。相反地，台灣肺腺癌年齡標準化發生率之男性年代增加率為67.41%、女性113.77%，國家於不同年齡層女性增加率大多高於男性。
結論: 於絕對性比較，女性比起男性無較高罹患肺腺癌的危險性；相對性比較中，於年代效應，女性有較高罹患肺腺癌之相對危險性。於年齡效應，男性有較高罹患肺腺癌之相對危險性。

Objective: The purpose of this study was to determine the gender comparison of lung adenocarcinoma for different age groups and period by use of absolute and relative index. Methods: Data was obtained from the IARC (International Agency for Research on Cancer) of the World Health Organization(WHO) the publication Cancer Incidence in Five Continents sixth to the eighth edition and the Taiwan Department of Health Cancer registration system provides total incidence of lung adenocarcinoma data, totally 18 countries(1983-1987 and 1993-1997). We calculated the directly age-standardized incidence rate (ASIR) of lung adenocarcinoma, age (30-44, 45-64 and 65-79) specific incidence rate, and the age- and period- increasing rate of lung adenocarcinoma in differences age groups and periods. Further we used the Poisson regression to estimate the relative risk and 95% confidence interval (95% CI).
Results: In 1983-1987 and 1993-1997, the ASIR raised from 4.94 to 8.27 among males and 3.05 to 6.52 among females per 100,000 persons in Taiwan. The ASIR among males was higher than females except Iceland and the male to females ratio in most countries declined as age increased. In Taiwan, used the age in 30-44 as baseline, in 1983-1987 at 45-64 and 65-79 years old in males of the increasing rate of lung adenocarcinoma was 965.12 % and 2468.22 %, females was 622.31% and1279.34%.
Most countries the lung adenocarcinoma increasing rate of males is higher than females, except India and Spain in 1983-1987. Contrary, in the period effect, Taiwanese age-standardized lung adenocarcinoma increasing rate was 67.41% among males and females was 113.77%, most countries the increasing rate of females in different age groups is higher than the males.
Conclusion: In the absolute comparison, females have not higher risk to develop lung adenocarcinoma than males. But in relative comparison, females have a higher relative risk of lung adenocarcinoma in period effect; Males have higher relative risk of lung adenocarcinoma in age effect.

表目錄…………………………………………………………………VII
圖目錄…………………………………………………………………VIII
第一章、前言……………………………………………………………1
第一節 研究動機………………………………………………………1
第二節 文獻探討………………………………………………………2
第三節 研究目的………………………………………………………4
第二章、材料與方法……………………………………………………5
第一節 資料來源………………………………………………………5
第二節 方法……………………………………………………………6
第三節 統計方法………………………………………………………6
第三章、研究結果………………………………………………………7
第一節 絶對指標………………………………………………………7
第二節 相對指標………………………………………………………10
第四章、討論……………………………………………………………12
參考文獻…………………………………………………………………16
附錄
附錄一、肺鱗狀細胞癌發生率性別比及年代增加率………………38
附錄二、肺鱗狀細胞癌發生率之年齡增加率………………………42
附錄三、調整後肺鱗狀細胞癌發生率之年代與年齡相對危險性……43
附錄四、肺鱗狀細胞癌發生率之絶對與相對指標圖示………………44

表目錄
Table1 Lung adenocarcinoma and lung squamous cell carcinoma incidence cases and population by 18 countries………………19
Table2 Lung adenocarcinoma incidence rate (per 100,000 person years) and increasing rate by 18 countries…………24
Table3 Lung adenocarcinoma incidence rate (per 100,000 person years) in age 30-44 and increasing rate by 18 countries………………………………………………………………25
Table4 The incidence rate of lung adenocarcinoma(per 100,000 person years) in age 45-64 and increasing rate by 18 countries……………………………………………………………26
Table5 The incidence rate of lung adenocarcinoma(per 100,000 person years) in age 65-79 and increasing rate by 18 countries……………………………………………………………27
Table6 The increasing rate(%) of lung adenocarcinoma by 18 countries in 1983-1987 and 1993-1997…………………………28
Table7 Results of Poisson regression model to estimate the adjusted relative risk for lung adenocarcinoma by 18 countries………………………………………………………………29


圖目錄
Figure 1a Incidence rates by lung histological cell type and gender in age 30-44……………………………………………30
Figure 1b Incidence rates by lung histological cell type and gender in age 45-64……………………………………………31
Figure 1c Incidence rates by lung histological cell type and gender in age 65-79……………………………………………32
Figure 2 The scatter plot of lung adenocarcinoma incidence rate by gender in three age groups……………………………33
Figure 3 Increasing rates of lung adenocarcinoma for period effect(1993-1997 versus 1983-1987) by gender…………………34
Figure 4 Increasing rate of lung adenocarcinoma for age effect(45-64 versus 30-44 and 65-79 versus 30-44) by gender…………………………………………………………………35
Figure 5 Adjusted relative risk(RR) of lung adenocarcinoma by gender(1993-1997 versus 1983-1987) …………………………36
Figure 6 Adjusted relative risk(RR) of lung adenocarcinoma by gender(45-64, 65-79 versus 30-44) …………………………37

1.台灣行政院衛生署，台灣國民十大癌症死因，2010。http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=11122&class_no=440&level_no=3, 2010/07/01
2.International Agency for Research on Cancer: IARC, World Cancer Report, 2008. http://globocan.iarc.fr/, 2010/07/01
3.台灣行政院衛生署癌症登記小組， 癌症申報發生人數按組織病理、性別及年齡分類，2010。http://www.bhp.doh.gov.tw/BHPnet/Portal/StatisticsShow.aspx?No=200911300001, 2010/07/01
4.Olak J, Colson Y. Gender differences in lung cancer: Have we really come a long way, baby? J Thorac Cardiovasc Surg 2004;128:346-351.
5.Ernster VL. Female lung cancer. Annu Rev Public Health 1996;17:97-114.
6.Jemal A, Travis WD, Tarone RE, Travis L, Devesa SS. Lung cancer rates convergence in young men and women in the United States: Analysis by birth cohort and histologic type. Int J Cancer 2003;105:101-107.
7.Bain C, Feskanich D, Speizer FE, Thun M, Hertzmark E, Rosner BA, Colditz GA. Lung Cancer Rates in Men and Women With Comparable Histories of Smoking. J Natl Cancer Inst 2004;96:826-834.
8.Kabir Z, Connolly GN, Clancy L. Sex-differences in lung cancer cell-types? An epidemiologic study in Ireland. Ulster Med. J. 2008;77:31-35.
9.Henschke CI, Miettinen OS. Women''s susceptibility to tobacco carcinogens. Lung Cancer 2004;43:1-5.
10.Osann KE, Anton-Culver H, Kurosaki T, Taylor T. Sex differences in lung-cancer risk associated with cigarette smoking. Int J Cancer 1993;54:44-48.
11.Harris R, Zang E, Anderson J, Wynder E. Race and sex differences in lung cancer risk associated with cigarette smoking. Int J Cancer 1993;22:592-599.
12.Zang E, Wynder E. Differences in lung cancer risk between men and women: examination of the evidence. J Natl Cancer Inst 1996;88:183-192.
13.Risch HA, Howe GR, Jain M, Burch JD, Holowaty EJ, Miller AB. Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type. Am J Epidemiol 1993;138:281-293.
14.Kreuzer M, Boffetta P, Whitley E, Ahrens W, Gaborieau V, Heinrich J, Jockel KH, Kreienbrock L, Mallone S, Merletti F, Roesch F, Zambon P, Simonato L. Gender differences in lung cancer risk by smoking: a multicentre case-control study in Germany and Italy. Br J Cancer 1999;82:227-233.
15.Brownson RC, Chang JC, Davis JR. Gender and histologic type variations in smoking-related risk of lung cancer. Epidemiology 1992;3:61-64.
16.Prescott E, Osler M, Hein HO, Borch-Johnsen K, Lange P, Schnohr P, Vestbo J. Gender and smoking-related risk of lung cancer. The Copenhagen Center for Prospective Population Studies. Epidemiology 1998;9:79-83.
17.Waterhouse J, Muir C, Correa P, Powell J. Cancer Incidence in Five Continents, V.III. Lyon: IARC Sci Publ 1976;No. 15.
18.Moller T, Anderson H, Aareleid T, Hakulinen T, Storm H, Tryggvadottir L, Corazziari I, Mugno E, Group EW. Cancer prevalence in Northern Europe: the EUROPREVAL study. Ann Oncol 2003;14:946-957.
19.Russo A, Crosignani P, Franceschi S, Berrino F. Changes in lung cancer histological types in Varese cancer registry, Italy 1976-1992. Eur J Cancer 1997;33:1643-1647.
20.Toyoda Y, Nakayama T, Ioka A, Tsukuma H. Trends in lung cancer incidence by histological type in Osaka, Japan. Jpn J Clin Oncol 2008;38:534-539.
21.Janssen-Heijnen ML, Coebergh JW. The changing epidemiology of lung cancer in Europe. Lung Cancer 2003;41:245-258.
22.Travis WD, Travis LB, Devesa SS. Lung cancer. Cancer 1995;75:191-202.
23.Fu JB, Kau TY, Severson RK, Kalemkerian GP. Lung cancer in women: analysis of the national Surveillance, Epidemiology, and End Results database. Chest 2005;127:768-777.
24.Boffetta P, Jarvholm B, Brennan P, Nyren O. Incidence of lung cancer in a large cohort of non-smoking men from Sweden. Int J Cancer 2001;94:591-593.
25.Simonato L, Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, Brennan P, Darby SC, Forastiere F, Fortes C, Gaborieau V, Gerken M, Gonzales CA, Jockel KH, Kreuzer M, Merletti F, Nyberg F, Pershagen G, Pohlabeln H, Rosch F, Whitley E, Wichmann HE, Zambon P. Lung cancer and cigarette smoking in Europe: an update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer 2001;91:876-887.
26.Brownson RC, Reif JS, Keefe TJ, Ferguson SW, Pritzl JA. Risk factors for adenocarcinoma of the lung. Am J Epidemiol 1987;125:25-34.
27.Lubin JH, Blot WJ. Assessment of lung cancer risk factors by histologic category. J Natl Cancer Inst 1984;73:383-389.
28.Khuder SA. Effect of cigarette smoking on major histological types of lung cancer: a meta-analysis. Lung Cancer 2001;31:139-148.
29.Wu AH, Henderson BE, Pike MC, Yu MC. Smoking and other risk factors for lung cancer in women. J Natl Cancer Inst 1985;74:747-751.
30.Kabat GC. Aspects of the epidemiology of lung cancer in smokers and nonsmokers in the United States. Lung Cancer 1996;15:1-20.
31.Levi F, Franceschi S, Vecchia CL, Randimbison L, Te V-C. Lung carcinoma trends by histologic type in Vaud and Neuchatel, Switzerland, 1974-1994. Cancer 1997;79:906-914.
32.Borras J, Borras JM, Galceran J, Sanchez V, Moreno V, Gonzalez JR. Trends in smoking-related cancer incidence in Tarragona, Spain, 1980-96. Cancer Causes Control 2001;12:903-908.
33.Forey B, Hamling J, Lee P, Wald N. In: International Smoking Statistics: a collectionof historical data from 30 economically developed countries(Second Edition). London: Oxford university Press 2002.
34.Morabia A, Wynder EL. Cigarette smoking and lung cancer cell types. Cancer 1991;68:2074-2078.
35.Chen F, Jackson H, Bina WF. Lung adenocarcinoma incidence rates and their relation to motor vehicle density. Cancer Epidemiol Biomarkers Prev 2009;18:760-764.
36.Liaw YP, Ting TF, Ho KK, Yang CF. Cell type specificity of lung cancer associated with air pollution. Sci Total Environ 2008;395:23-27.