臺灣博碩士論文加值系統

研究背景：口腔癌是國內十大癌症死亡率的第五名，男性十大癌症死亡率的第四位，近年來口腔癌的發生率與死亡率仍然逐年上升，台灣地區自西元2010年起在各層級的醫療院所全面推動口腔癌篩檢，希望降低口腔癌的發生率與提高口腔癌治療存活率，目前口腔癌篩檢主要針對年齡大於30歲，有抽菸或嚼食檳榔習慣的民眾。然而，時至今日，對於大規模口腔癌篩檢的成果與其影響效應仍缺乏深入研究。
研究目的：本研究探討分析有抽菸或嚼食檳榔族群接受口腔癌篩檢的結果，並分析口腔癌篩檢各種口腔癌前病灶或口腔癌的比例，統計分析影響口腔癌治療預後的相關影響因子，並比較經口腔癌篩檢發現口腔癌的族群與非經口腔癌篩檢的口腔癌族群，兩族群的癌症期別、癌症治療方式、腫瘤原發位置、癌症死亡率是否有所差異。
研究方法：研究收集自西元2010年1月至2014年12月底，在嘉義某區域教學醫院口腔癌篩檢的個案，與同一時間內確診為口腔癌的個案，做回溯性研究，分別記錄年齡、性別、腫瘤期別、治療方式及癌症部位等資料，進行口腔癌治療存活預後因子的分析，並進一步區分為經口腔癌篩檢確診為口腔癌之組群，與未接受口腔癌篩檢診斷為口腔癌之族群，利用Kaplan-Meier存活曲線探討，比較兩組治療存活率之差異。
研究結果：五年內共篩檢27856人次，口腔癌篩檢呈現篩檢異常的個案共有3828人次，整體口腔癌篩檢異常比率約為13.74%，篩檢異常病灶以白斑最為常見。五年內新診斷的口腔癌個案共有726位，經口腔癌篩檢確診為口腔癌納入研究的有129位，非經口腔癌篩檢的口腔癌個案數有579位，男性病人佔大多數，有680位，約佔93.7%。統計各治療預後之相關因子，發現年齡65歲以上(風險比率2.14, p<0.001)，癌症期別第IVA,IVB+IVC期(風險比率為3.76, p<0.001及8.03, p<0.001)，治療方式僅接受放射線治療或是僅接受放射線合併化學治療(風險比率3.09, p<0.05及2.41, p<0.05)，腫瘤原發部位在口腔底部(風險比率2.26, p<0.05)等為口腔癌治療存活率較差的影響因子。至於口腔癌篩檢族群雖然死亡率較非經口腔癌篩檢族群有下降趨勢，但是統計學上沒有達到顯著差異。
結論：研究結果顯示有抽菸或吃檳榔習慣的族群口腔癌的發生率明顯高於一般群眾，影響口腔癌治療預後較差的相關因子包括年紀大於65歲、口腔癌腫瘤期別第四期、僅接受放射線治療或是僅接受放射線合併化學治療，以及原發部位於口腔底部的癌症。所以早期篩檢並早期接受手術治療，能有效的提高口腔癌治療的預後。此外從研究結果推論對口腔癌高危險群實施大規模口腔癌篩檢有助於降低口腔癌治療後的死亡率的趨勢，但是其更顯著的成果仍然需要後續更大型的研究證實。

Background: Oral cancer is the fifth leading cause of cancer death in Taiwan and is also the fourth leading cause of cancer death for males. The incidence and mortality rate of oral cancer in Taiwan has increased year by year. The large population based oral cancer screening was implemented since 2010 in Taiwan. The purpose of large population based oral cancer screening is to detect early stage oral cancer patients and to improve the treatment outcome of oral cancer. Currently, the program of oral cancer screening program is focus on the high risk group with the habit of smoking or betel quid chewing. Little attention had been paid to the result and the effect of oral cancer screening even now.
Purpose: The objective of this study is to evaluate the results of oral cancer screening for the high-risk group with the habit of smoking or betel quid chewing. We analyzed the incidence rate of precancerous lesion and oral cancer. Clinical prognostic factors for oral cancer were also recorded and analyzed. In addition, relevant clinical factors such as cancer stage, cancer treatment modalities, tumor location, mortality rate were compared between oral cancer screening group and non-screening group.
Methods: From January 2010 to December 2014, all participants who received oral cancer screening and all newly diagnosed oral cancer patients in one regional teaching hospital were enrolled. This is a retrospective study design and relevant clinical data including of age、sex、tumor staging、treatment modalities、tumor location were recorded for assessment of oral cancer survival rate. Kaplan-Meier survival curves between oral cancer screening group and non-screening group were compared.
Results: 3828 individuals were screened positive among all 27856 eligible participants. The positive rate of all precancerous lesion and oral cancer is 13.74% and the most common lesion is leukoplakia. Of the 726 newly diagnosed oral cancer individuals, 129 individuals were enrolled from oral cancer screening group and 579 individuals were non-screening group. Male patients accounted for 93.7% (n=680) of oral cancer patients. Poor prognostic clinical factors for oral cancer survival included: Age > 65 years old(Hazard ratio: 2.14, p<0.001)，cancer stage IVA, IVB+IVC(Hazard ratio: 3.76, p<0.001 and 8.01, p<0.001)，treatment modalities of radiotherapy alone or concurrent chemoradiotherapy alone (Hazard ratio: 3.09, p<0.05 and 2.41, p<0.05)，tumor location of mouth floor(Hazard ratio: 2.26, p<0.05). Although the mortality rate of oral cancer screening group had the trend of decrease, the difference between two groups is not significant.
Conclusion: The estimated incidence of oral cancer among those with the habit of cigarette smoking and betel quid chewing is significant higher than general population. The poor prognostic factors for oral cancer survival included: older age、advanced cancer stage, treatment modalities of radiotherapy alone or concurrent chemoradiotherapy alone and mouth floor cancer. Early detection of oral cancer and receive adequate surgery or adjuvant therapy is the key to improve the survival. In addition, we supposed that large population based oral cancer screening for high risk group had the trend to decrease mortality rate of oral cancer. Further larger population study may make its clinical significance to be more obviously in the future.

目錄
摘要 i
英文摘要 iii
謝誌 v
目錄 vi
圖目錄 viii
表目錄 ix

第一章、 緒論......................................................................................................................................1
第一節、 研究背景......................................................................................................................1
第二節、 研究動機與目的..........................................................................................................2
第二章、 文獻探討..............................................................................................................................4
第一節、 口腔癌前病變與口腔癌之概述..................................................................................4
第二節、 臺灣地區口腔癌篩檢與治療流程..............................................................................8
第三節、 口腔癌的診斷與治療................................................................................................11
第四節、 影響口腔癌存活率之文獻探討................................................................................14
第三章、 研究設計與方法................................................................................................................17
第一節、 理論與實證模型........................................................................................................17
第二節、 研究架構與研究流程................................................................................................19
第三節、 統計方法....................................................................................................................22
第四節、 研究變項設定............................................................................................................25
第四章、 研究結果............................................................................................................................28
第一節、 口腔癌篩檢個案的樣本特性與篩檢結果................................................................28
第二節、 影響口腔癌治療預後的相關因子探討....................................................................31
第三節、 口腔癌篩檢對於口腔癌預後之影響探討................................................................35
第五章、 討論....................................................................................................................................39
第一節、 口腔癌篩檢之結果分析與探討................................................................................39
第二節、 口腔癌治療存活率相關因子探討............................................................................40
第三節、 口腔癌篩檢對於口腔癌存活率之影響探討............................................................42
第六章、 結論與建議 ......................................................................................................................45
第一節、 結論............................................................................................................................45
第二節、 研究限制與建議........................................................................................................46
參考文獻............................................................................................................................................48

中文部分
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