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研究生:廖先啟
研究生(外文):Hsien-Chi Liao
論文名稱:常規性胸腔外掃描對於T1x非小細胞肺癌患者之適切性
論文名稱(外文):Is Routine Scanning Necessary for Detecting Extrathoracic Metastases in Patients with Non-small Cell Lung Cancer under Stage T1x?
指導教授:鍾國彪鍾國彪引用關係陳晉興陳晉興引用關係
指導教授(外文):Kuo-Piao ChungJin-Shing Chen
口試日期:2017-07-18
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
學門:醫藥衛生學門
學類:公共衛生學類
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:37
中文關鍵詞:非小細胞肺癌肺癌分期腦部轉移
外文關鍵詞:non-small cell lung cancerlung cancer stagingbrain metastasis
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研究背景
近年來,肺癌已被統計是國內發生率最高的癌症之一,多數病人被診斷時都已屆末期,因此造成高死亡率。雖然肺癌的整體病程預後不佳,但肺癌患者的期別的判定,往往很大程度的影響其疾病治療進程。

研究目的
作為一名胸腔外科醫師,篩選出初期肺癌病患,並給予手術治療是我們的主要工作之ㄧ。然而透過多年臨床實務,我們發現最初期的非小細胞肺癌病患,其實罕有遠端轉移情況,但又苦無直接證據佐證,能否在低風險下省略多項掃描。
研究方法
利用臺大醫院肺癌登記庫為樣本,於病歷系統、影像系統、癌症管理系統分析統整2005至2015年間,所有非小細胞肺癌個案之相關訊息,建立起所需之研究資料庫。資料庫建置完畢後,再依照腫瘤大小及癌症期別分類,挑選出腫瘤直徑小於三公分以下之個案,分析其腦部轉移機率、骨骼轉移機率、以及其他遠端轉移之可能性。利用風險比、上升趨勢線等,藉以探討現行之常規性全身掃描是否有必要,和該疾病最為相關之風險因子為何。

研究結果
對於一公分以下之非小細胞肺癌,幾乎無腦部及骨骼轉移機率,故無須進行腦部斷層及骨骼掃描。但超過一公分以上者風險快速增加,有掃描之必要。

預期貢獻
本研究之預期貢獻有以下三點:
1.回應臨床端之需求:在何種條件下,非小細胞肺癌之病患,可以免除常規性胸腔外掃描之實行,以節省大量之金錢、時間及體力消耗。
2.針對小體積非小細胞肺癌而言,找出可能相關影響腫瘤遠端轉移之主要風險因子。
3.藉由本研究之成果,建立特定高風險族群,為日後大規模肺癌篩檢作為參考。
Abstract

Background
In recent years, statistics show that lung cancer is one of the cancers with higher incidence rates in Taiwan. Most patients are at terminal stage when diagnosed with lung cancer, so there is a high mortality rate. Although the overall prognosis is poor, the staging of lung cancer still has a major impact on its progression and treatment.

Objectives
As a thoracic surgeon, we are to screen lung cancer patients at their initial stage and to give them surgical treatment if possible. Many years of clinical work tells us that non-small cell lung cancer at initial stage rarely has distant metastasis. However, we now lack the direct evidence whether some scans are unnecessary at such low risks of metastases.

Methods
This study enrolled the non-small cell lung cancer cases in our lung cancer database at National Taiwan University Hospital from 2005 to 2015. Then, we analyzed the metastasis rates to brain, bone and other distant locations of these tumors with diameters less than 3 cm. By interpreting the risk ratios and the ascending trend lines, we discussed the necessity of some routinely performed whole body scans and the risk factors associated with metastases.

Results
For non-small cell lung cancers smaller than 1 cm, there was almost no brain or bone metastasis. Thus, there is no need for brain and bone scans. However, scans are suggested for those non-small cell lung cancers greater than 1 cm, as they have growing rates of metastases.

There are 3 expected contributions of this study:
1.To answer the clinical question that in what conditions, patients of non-small cell lung cancers can neglect non-chest scanning. This will save money, time and energy expenditure.
2.To find the risk factors for distant metastases for non-small cell lung cancers with small sizes.
3.To establish a definition of high risk group for future large sample sized lung cancer screening.

Key Words
non-small cell lung cancer, lung cancer staging, brain metastasis.
目 錄
表 目錄 3
摘 要 4
第一章 緒 論 6
第一節 實習單位簡介 6
第二節 研究背景及現況 7
第三節 當前準則與研究重要性 10
第四節 研究目的 13
第二章 文獻探討 15
第一節 非小細胞肺癌臨床期別與病理期別診斷之落差 15
第二節 非小細胞肺癌臨床症狀表現與轉移風險的關係 16
第三節 肺癌病人腦部轉移偵測工具的比較 17
第四節 國外大規模篩檢之回顧結果 18
第五節 其他文獻回顧整理 20
第三章 研究方法 21
第一節 研究對象 21
第二節 研究架構與研究變項 22
第三節 收案條件與排除條件 24
第四節 研究假說 25
第五節 統計分析方法 25
第四章 研究結果與討論 28
第五章 結論與建議 34
第一節 研究單位 34
第二節 結論 34
第三節 臨床及政策建議 35
參考文獻 36
參考文獻
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9.Lopez-Encuentra, A., et al., Comparison between clinical and pathologic staging in 2,994 cases of lung cancer. Ann Thorac Surg, 2005. 79(3): p. 974-9; discussion 979.
10.Win, T., et al., The value of performing head CT in screening for cerebral metastases in patients with potentially resectable non-small cell lung cancer: experience from a UK cardiothoracic centre. Clin Radiol, 2004. 59(10): p. 935-8.
11.Yokoi, K., et al., Detection of brain metastasis in potentially operable non-small cell lung cancer: a comparison of CT and MRI. Chest, 1999. 115(3): p. 714-9.
12.Black, W.C., et al., Cost-effectiveness of CT screening in the National Lung Screening Trial. N Engl J Med, 2014. 371(19): p. 1793-802.
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16.Dhooria, S., et al., Diagnostic Yield and Complications of EBUS-TBNA Performed Under Bronchoscopist-directed Conscious Sedation: Single Center Experience of 1004 Subjects. J Bronchology Interv Pulmonol, 2017. 24(1): p. 7-14.
17.Phua, C.K., et al., Evaluation of pulmonary nodules in Asian population. J Thorac Dis, 2016. 8(5): p. 950-7.
18.Tagliabue, L., G. Manfrinato, and A. Luciani, An Unusual Case of Myocardial Localization of Non-Small Cell Lung Cancer Metastasis: A Case Report and Review of Literature. Indian J Nucl Med, 2017. 32(3): p. 208-210.
19.Dias, M., et al., Prognostic impact of M descriptors of the 8th edition of TNM classification of lung cancer. J Thorac Dis, 2017. 9(3): p. 685-691.
20.Cox, M.L., et al., The Role of Extent of Surgical Resection and Lymph Node Assessment for Clinical Stage I Pulmonary Lepidic Adenocarcinoma: An Analysis of 1991 Patients. J Thorac Oncol, 2017. 12(4): p. 689-696.
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