臺灣博碩士論文加值系統

肝細胞癌(以下簡稱為肝癌)為全球第五大常見癌症，佔癌症死亡原因第二名，近年醫學上對於肝癌的治療有許多進展，過去有關癌症的研究，多著重於癌症預防、臨床診斷、臨床治療，然而較少探討首次治療時間，另一方面，文獻上對於首次治療時間與存活之相關性亦尚無定論，因此本研究探討新診斷的肝癌病人，從首次診斷至首次治療天數之分布情形，進一步了解其與存活率的關係及影響治療時程的相關因子。
本研究屬回溯性研究，運用某醫學中心癌症登記資料，針對2011-2013年新診斷且接受首次治療的1623位肝癌病人，以Cox proportional hazard model 及K-M存活分析，探討BCLC分期、治療方式、首次治療時間與存活之關係。
研究結果顯示C型肝炎、胎兒蛋白、BCLC C期、接受局部治療為影響治療時程之相關因子。在BCLC分期、治療方式與首次治療時間之存活分析，無論將癌症分期、治療方式單獨或合併與首次治療時間進行分析，研究結果絕大多數為延遲治療不會影響平均存活月數，少部分顯示延遲治療會影響平均存活月數，且發現被歸為延遲治療組之存活月數高於非延遲治療組。
本研究運用不同時間做為首次治療時間分界，結果顯示肝癌病人之存活仍與腫瘤分期、治療方式息息相關，同時發現肝癌病人的肝炎情形、治療評估的時程、治療探針或藥物的審核時程會影響首次治療時間，因本資料庫所登錄之資料有限，觀察樣本及時間亦不足，故首次治療時間是否會影響存活尚無定論，有待後續研究能了解首次治療時間與存活之關係。

Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide. In recent years, the treatments of HCC have more progress, but there is no conclusive definition for the duration of initial treatment in delay. The relationship between the duration of initial treatment and survival of HCC is also not reaching the determination. The purpose of this study is to investigate the duration from the first time diagnosis to the first treatment among newly diagnosed HCC patients.
It was a retrospective study and we conducted the cancer registry database from a medical center during 2011-2013. The newly diagnosed HCC patients were 1629 cases remained after selection criteria. We used Cox proportional hazard model and Kaplan-Meier survival analysis to calculate the distribution of duration the initial diagnosis to the first time treatment and explore the relationship between the BCLC stagings, treatment and survival duration with determining factors.
Results from this study found that hepatitis C, AFP, BCLC stage C, and received topical remedy patients, were the impact factors associated with duration of initial treatment. Regarding the cancer stages, or treatment, we found that the delay in treatment was not significantly related with the survival months in most situations which either used stage or treatment separately or coincidently in the study groups. Only some results revealed that the delay in treatment was associated with the survival months while the survival months in the delayed treatment group was longer than in the non-delay treatment group.
We used the week period to divide the duration of initial treatment for the study purpose. The results showed that tumor stages and treatments were associated with the survival risk. In the meantime, hepatitis patients, the duration of treatment assessment, drug probe or the duration of treatment audit were the factors related to the duration of first time treatment. Due to the information in this database with limited observation period and sample size, the relationship between the survival risk and the duration of first time treatment was indeterminate for the further research to provide more evidence.

目錄
第一章 緒論 1
第一節 前言 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 肝癌 3
第二節 首次治療時間 9
第三章 研究設計與方法 11
第一節 研究架構 11
第二節 研究設計 12
第四章 研究結果 15
第一節 肝癌病人之基本屬性 15
第二節 影響肝癌病人首次治療時間之相關因子 18
第三節 BCLC分期與首次治療時間之存活分析 21
第四節 治療方式與首次治療時間之存活分析 27
第五節 各BCLC分期治療方式與首次治療時間之存活分析 34
第五章 討論及建議 45
第六章 研究結論 49
參考文獻 51

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