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研究生:楊博喻
研究生(外文):Po-Yu Yang
論文名稱:利⽤用全民健康保險資料庫分析台灣地區⼝腔黏膜下纖維化症惡性轉化成口腔癌的情形
論文名稱(外文):Malignant transformation of oral submucous fi゙brosisin Taiwan: A nationwide population-based retrospective cohort studyretrospective cohort study
指導教授:李慈心李慈心引用關係蕭志同蕭志同引用關係余承佳謝宗明謝宗明引用關係
學位類別:博士
校院名稱:中山醫學大學
系所名稱:牙醫學系博士班
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:83
中文關鍵詞:世代研究惡性轉化全國性⼈研究口腔黏膜下纖維
外文關鍵詞:cohort studymalignant transformationnationwide populationoral submucous
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口腔黏膜下纖維化症,是眾所週知的口腔癌前病變,本研究的目的在於探討台灣地區口腔黏膜下纖維化症惡性轉化成口腔癌的情形。本篇文章透過全民健康保險研究資料庫,選取出被診斷為口腔黏膜下纖維化症的實驗組別,剩下不曾被診斷出纖維化的群體,再根據年紀、性別及指標日期配對出對照組別,比較兩個組別之間的差異性。同時將口腔白斑列入分析,評估是否造成口腔黏膜下纖維化症惡性轉化協同效果。結果顯示,在778個纖維化症患者中有71人 ( 9.13% ) 觀察到惡性轉化成口腔癌。經過校正後,發現纖維化症的組別中,惡性轉化的風險比率為對照組別的29.26倍 ( 95%信賴區間為20.55-41.67 )。而同時罹患口腔白斑與口腔黏膜下纖維化症的患者,有更高的惡性轉化風險( 52.46倍 ; 95%信賴區間為 34.88-78.91 )。存活分析 ( The Kaplan-Meier plot ) 的結果顯示出,在觀察的期間,兩個組別之間有顯著性差異 ( log-rank test, p<0.001 )。平均發生惡性轉化的時間如下:非纖維化症組別為5.1年、纖維化症組別為2.7年、同時罹患口腔白斑與纖維化症組別為2.2年。綜合以上結果我們發現,台灣地區的口腔黏膜下纖維化症患者比起非纖維化症患者來說,有較高的風險發生惡性轉化成口腔癌。同時口腔白斑可能會提高黏膜下纖維化症患者發生惡性轉化的風險。
Background : Oral submucous fi゙brosis ( OSF ) is one of the well-recognized oral potentially malignant disorders. In this study, we investigated the malignant transformation of OSF in a Taiwanese population. Methods : A retrospective cohort study was analyzed from Taiwan’s National Health Insurance Research Database.
A comparison cohort was randomly frequency matched with the OSF cohort according to age, sex, and index year. Oral leukoplakia ( OL ) was further stratifi゙ed to evaluate for the possible synergistic effects of OSF-associated malignant transformation. Results : In this cohort, 71 ( 9.13% ) of 778 cases of OSF were observed to transform into oral cancer. The malignant transformation rate was
29.26-fold in the OSF cohort than in the comparison cohort after adjustment ( 95% confi゙dence intervals 20.55-41.67 ). To further stratify with OL, OSF with OL( 52.46%; 95% confi゙dence intervals 34.88-78.91 ) had higher risk of malignant transformation rate than OSF alone ( 29.84%; 95% confi゙dence intervals 20.99-42.42 ). The Kaplan-Meier plot revealed the rate free of malignant transformation was signifi゙cant over the 13-year follow-up period ( log-rank test, P<.001 ). The mean duration of malignant transformation was 5.1, 2.7, and 2.2 years for non-OSF, OSF alone, and OSF with OL, respectively. Conclusion : Oral submucous fi゙brosis patients exhibited a signifi゙cantly higher risk of malignant transformation
than those without OSF. OL could enhance malignant transformation in patients with OSF.
中⽂文摘要...........................................................................................1
英⽂文摘要...........................................................................................2
第一章緒論...........................................................................................3
第一節口腔黏膜下纖維化症的介紹.......................................................4
1.1 ⼝腔黏膜下纖維化症的流⾏行病學.................................................4
1.2 檳榔的⾷食⽤用習慣及流⾏行病學.................................................6
1.3 口腔黏膜下纖維化症的組織學特徵.................................................7
1.4 檳榔的成份.....................................................................................9
1.5 口腔黏膜下纖維化症的治療⽅方法...............................................13
1.6 口腔黏膜下纖維化症的基因多形性...............................................14
第二節口腔黏膜下纖維化症的惡性傾向..............................................15
2.1 口腔潛在惡性疾病........................................................................15
2.2 口腔黏膜下纖維化症惡性轉化的機制............................................17
第三節其他⼝口腔潛在惡性疾病.........................................................25
3.1 口腔白斑......................................................................................25
3.2 口腔扁平苔蘚...............................................................................28
第四節口腔癌.....................................................................................32
第五節台灣全民健康保險研究資料庫..................................................35
5.1 醫療保險系統介紹........................................................................35
5.2 全民健康保險研究資料庫.............................................................38
第六節研究動機.................................................................................41
第⼆章實驗設計及⽅方法...................................................................42
第⼀節資料來源.................................................................................42
第⼆節研究對象.................................................................................43
第三節觀察終點..................................................................................45
第四節統計方法及資料分析................................................................46
第三章結果.........................................................................................47
第四章討論.........................................................................................50
第五章結論.........................................................................................56
第六章圖表說明..................................................................................58
第七章參考文獻.......................................,,,........................................69
第八章附錄.........................................................................................77
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