臺灣博碩士論文加值系統

根據世界衛生組織統計，大腸癌在2012年為全球癌症罹患中排名第三位，而在國民健康署2014年統計，台灣地區大腸癌是所有癌症死亡率的第三位，癌症發生率的第一位。此外，由於國人的生活及飲食習慣逐漸改變，國人罹患高血壓、高血糖及高血脂盛行率呈現上升之趨勢。近年來有研究報告表示高血壓、高血糖及高血脂與罹患大腸癌具有關聯性，而有的研究報告則不具有關聯性，研究文獻報告結果不一致。因此，本研究以具有台灣族群代表性的研究樣本進行世代研究，探討高血壓、高血糖、高血脂與新發診斷大腸癌之關聯性。
本研究以族群為基礎的世代研究，採用國民健康署「2002年台灣地區高血壓、高血糖、高血脂之盛行調查研究」，具有台灣族群代表性的研究對象，共計6131名。研究工具採用面訪問卷、測量記錄及檢體採集資料進行分析。統計方法採用Cox regression以估計風險比(hazard ratio, HR)與95%信賴區間(confidence interval, CI)來表示相關性的強度及統計的顯著性。另並繪製Kaplan-Meier曲線分別比較有無高血壓、高血糖及高血脂在追蹤期間罹患大腸癌機率及使用log-rank test來檢查各組間差異的顯著性。
結果顯示有高血糖個案比無高血糖個案，顯著增加罹患大腸癌累積發生風險，Log-rank p value <0.001。進一步在罹患大腸癌多變項Cox廻歸分析結果顯示高血糖顯著增加罹患大腸癌風險(HR=2.51；95%CI：1.28-4.93)。
在高血壓、高血糖、高血脂與新發診斷大腸癌之關聯性，本研究顯示高血糖顯著增加罹患大腸癌風險。因為高血壓、高血糖及高血脂往往會相伴出現，建議將來的追蹤研究能夠深入探討高血壓、高血糖與高血脂之共伴效應對於罹患大腸癌風險之影響。

IN the World Health Organization GLOBOCAN database, colorectal cancer was the third most common cancer in the world in 2012. In addition, according to the statistics of the Health Promotion Administration in Taiwan, colorectal cancer was the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths in Taiwan in 2014. Notably, the prevalences of hypertension, hyperglycemia and hyperlipidemia showed a rising trend in Taiwan. The findings from epidemiologic studies on the associations of hypertension, hyperglycemia and hyperlipidemia with colorectal cancer risk have been conflicting. The purpose of this study was to examine the associations of hypertension、hyperglycemia and hyperlipidemia with colorectal cancer in Taiwanese population.
Data was derived from a nationwide population-based “2002 Survey on the Prevalence of Hypertension, Hyperglycemia and Hyperlipidemia in Taiwan”. All participants underwent questionnaire interview, anthropometric and blood pressure measures and blood sample collection. Kaplan-Meier cumulative-incidence plots of colorectal cancer and two-sided nominal P values derived from the log-rank statistic were presented for hypertension, hyperglycemia and hyperlipidemia. In addition, the Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals(95%CI).
The results of this study showed that the cumulative incidence of colorectal cancer was greater in the hyperglycemic group than in the non-hyperglycemic group (Log-rank test p value <0.001). The multivariable Cox regression model showed that hyperglycemia was a significant predictor for colorectal cancer (HR, 2.51; 95% CI,1.28-4.93).
These findings indicated that hyperglycemia was associated with an increased risk of colorectal cancer in Taiwan.

正文目錄……………………………………………………………………… Ⅰ
圖表目錄……………………………………………………………………… Ⅲ
中文摘要……………………………………………………………………… Ⅳ
英文摘要(Abstract)…………………………………………………………… Ⅴ
第一章 緒論…………………………………………………………………… 1
第一節 研究背景及重要性…………………………………………………… 1
第二節 研究目的……………………………………………………………… 2
第二章 文獻探討……………………………………………………………… 3
第一節 大腸癌簡介…………………………………………………………… 3
第二節 大腸癌現況…………………………………………………………… 7
第三節 大腸癌相關影響因子………………………………………………… 11
第四節 高血壓、高血糖及高血脂與大腸癌之相關性……………………… 14
第三章 材料與方法…………………………………………………………… 21
第一節 研究設計……………………………………………………………… 21
第二節 研究對象……………………………………………………………… 22
第三節 研究工具……………………………………………………………… 25
第四節 研究變項定義………………………………………………………… 27
第五節 統計分析……………………………………………………………… 29
第四章 研究結果……………………………………………………………… 30
第一節 研究對象基本資料分析……………………………………………… 30
第二節 高血壓、高血糖及高血脂之新發診斷大腸癌累積發生風險……… 32
第三節 新發診斷大腸癌的基本特質、生化測量值及生活型態分佈……… 32
第四節 新發診斷大腸癌在基本特質、生化測量值及生活型態的風險比… 33
第五節 高血壓、高血糖及高血脂與新發診斷大腸癌多變項Cox廻歸分析…34
第五章 討論…………………………………………………………………… 47
第一節 影響大腸癌之危險因素……………………………………………… 47
第二節 高血壓、高血糖、高血脂與大腸癌的相關之探討………………… 49
第三節 研究優勢與限制……………………………………………………… 52
第六章 結論…………………………………………………………………… 53
第七章 參考文獻……………………………………………………………… 54

一、英文參考文獻
Agnoli, C., Grioni, S., Sieri, S., Sacerdote, C., Vineis, P., Tumino, R., Giurdanella, M. C., Pala, V., Mattiello, A., Chiodini, P., Iacoviello, L., De Curtis, A., Cattaneo, L., van Duijnhoven, F. J., Panico, S., & Krogh, V. (2014). Colorectal cancer risk and dyslipidemia: a case-cohort study nested in an Italian multicentre cohort. Cancer Epidemiol, 38(2), 144-151.
Ahmed, R. L., Schmitz, K. H., Anderson, K. E., Rosamond, W. D., & Folsom, A. R. (2006). The metabolic syndrome and risk of incident colorectal cancer. Cancer, 107(1), 28-36.
Ahn, J., Lim, U., Weinstein, S. J., Schatzkin, A., Hayes, R. B., Virtamo, J., & Albanes, D. (2009). Prediagnostic total and high-density lipoprotein cholesterol and risk of cancer. Cancer Epidemiol Biomarkers Prev, 18(11), 2814-2821.
Aleksandrova, K., Boeing, H., Jenab, M., Bas Bueno-de-Mesquita, H., Jansen, E., van Duijnhoven, F. J., Fedirko, V., Rinaldi, S., Romieu, I., Riboli, E., Romaguera, D., Overvad, K., Ostergaard, J. N., Olsen, A., Tjonneland, A., Boutron-Ruault, M. C., Clavel-Chapelon, F., Morois, S., Masala, G., Agnoli, C., Panico, S., Tumino, R., Vineis, P., Kaaks, R., Lukanova, A., Trichopoulou, A., Naska, A., Bamia, C., Peeters, P. H., Rodriguez, L., Buckland, G., Sanchez, M. J., Dorronsoro, M., Huerta, J. M., Barricarte, A., Hallmans, G., Palmqvist, R., Khaw, K. T., Wareham, N., Allen, N. E., Tsilidis, K. K., & Pischon, T. (2011). Metabolic syndrome and risks of colon and rectal cancer: the European prospective investigation into cancer and nutrition study. Cancer Prev Res (Phila), 4(11), 1873-1883.
Amersi, F., Agustin, M., & Ko, C. Y. (2005). Colorectal cancer: epidemiology, risk factors, and health services. Clin Colon Rectal Surg, 18(3), 133-140.
American Diabetes Association.(2014). Diagnosis and classification of diabetes mellitus. Diabetes Care, 37 Suppl 1, S81-90.
Barrasa, J. I., Olmo, N., Lizarbe, M. A., & Turnay, J. (2013). Bile acids in the colon, from healthy to cytotoxic molecules. Toxicol In Vitro, 27(2), 964-977.
Berster, J. M., & Goke, B. (2008). Type 2 diabetes mellitus as risk factor for colorectal cancer. Arch Physiol Biochem, 114(1), 84-98.
Bird, C. L., Ingles, S. A., Frankl, H. D., Lee, E. R., Longnecker, M. P., & Haile, R. W. (1996). Serum lipids and adenomas of the left colon and rectum. Cancer Epidemiol Biomarkers Prev, 5(8), 607-612.
Bloch, M. J. (2016). Worldwide prevalence of hypertension exceeds 1.3 billion. J Am Soc Hypertens, 10(10), 753-754.
Boland, C. R. (2004). Understanding familial colorectal cancer-finding the corner pieces and filling in the center of the puzzle. Gastroenterology, 127(1), 334-338.
Borena, W., Stocks, T., Jonsson, H., Strohmaier, S., Nagel, G., Bjorge, T., Manjer, J., Hallmans, G., Selmer, R., Almquist, M., Haggstrom, C., Engeland, A., Tretli, S., Concin, H., Strasak, A., Stattin, P., & Ulmer, H. (2011). Serum triglycerides and cancer risk in the metabolic syndrome and cancer (Me-Can) collaborative study. Cancer Causes Control, 22(2), 291-299.
Botteri, E., Iodice, S., Bagnardi, V., Raimondi, S., Lowenfels, A. B., & Maisonneuve, P. (2008). Smoking and colorectal cancer: a meta-analysis. JAMA, 300(23), 2765-2778.
Bowman, T. S., Gaziano, J. M., Buring, J. E., & Sesso, H. D.(2007). A prospective study of cigarette smoking and risk of incident hypertension in women. J Am Coll Cardiol, 50(21), 2085-2092.
Boyle, P., & Langman, J. S. (2000). ABC of colorectal cancer: Epidemiology. Br Med J, 321(7264), 805-808.
Calle, E. E., Miracle-McMahill, H. L., Thun, M. J., & Heath, C. W. Jr. (1995). Estrogen replacement therapy and risk of fatal colon cancer in a prospective cohort of postmenopausal women. J Natl Cancer Inst, 87(7), 517-23.
Cappell, M. S. (2005). From colonic polyps to colon cancer: pathophysiology, clinical presentation, and diagnosis. Clin Lab Med, 25(1), 135-177.
Center, M. M., Jemal, A., & Ward, E. (2009). International trends in colorectal cancer incidence rates. Cancer Epidemiol Biomarkers Prev, 18(6), 1688-1694.
Chang, H. Y., Hsu, C. C., Pan, W. H., Liu, W. L., Cheng, J. Y., Tseng, C. H., Bai, C. H., Yeh, W. T., & Hurng, B. S. (2010). Gender differences in trends in diabetes prevalence from 1993 to 2008 in Taiwan. Diabetes Res Clin Pract, 90(3), 358-364.
Chen, K., Qiu, J. L., Zhang, Y., & Zhao, Y. W. (2003). Meta analysis of risk factors for colorectal cancer. World J Gastroenterol, 9(7), 1598-1600.
Chiang, C. E., Wang, T. D., Ueng, K. C., Lin, T. H., Yeh, H. I., Chen, C. Y., Wu, Y. J., Tsai, W. C., Chao, T. H., Chen, C. H., Chu, P. H., Chao, C. L., Liu, P. Y., Sung, S. H., Cheng, H. M., Wang, K. L., Li, Y. H., Chiang, F. T., Chen, J. H., Chen, W. J., Yeh, S. J., & Lin, S. J. (2015). 2015 guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the management of hypertension. J Chin Med Assoc, 78(1), 1-47.
Chiu, H. M., Lin, J. T., Shun, C. T., Liang, J. T., Lee, Y. C., Huang, S. P., & Wu, M. S. (2007). Association of metabolic syndrome with proximal and synchronous colorectal neoplasm. Clin Gastroenterol Hepatol, 5(2), 221-229.
Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., Jones, D. W., Materson, B. J., Oparil, S., Wright, J. T., Jr., & Roccella, E. J. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA, 289(19), 2560-72.
Coppola, J. A., Shrubsole, M. J., Cai, Q., Smalley, W. E., Dai, Q., Ness, R. M., Fazio, S., Zheng, W., & Murff, H. J. (2015). Plasma lipid levels and colorectal adenoma risk. Cancer Causes Control, 26(4), 635-643.
Cowey, S., & Hardy, R. W. (2006). The metabolic syndrome: A high-risk state for cancer? Am J Pathol, 169(5), 1505-1522.
Day, D. W., & Morson , B. C. (1978). The adenoma-carcinoma sequence. Major Probl Patho, 10(1), 58-71.
de la Chapelle, A. (2004). Genetic predisposition to colorectal cancer. Nat Rev Cancer, 4(10), 769-780.
Duan, W., Shen, X., Lei, J., Xu, Q., Yu, Y., & Li, R. (2014). Hyperglycemia, a neglected factor during cancer progression. Biomed Res Int 2014, Article ID 461917.
Esteve, E., Ricart, W., & Fernandez-Real, J. M. (2005). Dyslipidemia and inflammation: an evolutionary conserved mechanism. Clin Nutr, 24(1), 16-31.
Expert panel on detection, evaluation, and treatment of high blood cholesterol in adults. (2003). Executive summary of the third report of the national cholesterol education program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA, 285(19), 2486-97.
Frezza, E. E., Wachtel, M. S., & Chiriva-Internati, M. (2006). Influence of obesity on the risk of developing colon cancer. Gut, 55(2), 285-291.
Giovannucci, E. (2007). Metabolic syndrome, hyperinsulinemia, and colon cancer: a review. Am J Clin Nutr, 86(3), s836-842.
Giovannucci, E., Harlan, D. M., Archer, M. C., Bergenstal, R. M., Gapstur, S. M., Habel, L. A., Pollak, M., Regensteiner, J. G., & Yee, D. (2010). Diabetes and cancer: a consensus report. Diabetes Care, 33(7), 1674-1685.
Grodstein, F., Newcomb, P. A., & Stampfer, M. J.(1999). Postmenopausal hormone therapy and the risk of colorectal cancer: a review and meta-analysis. Am J Med, 106(5), 574-582.
Haggar, F. A., & Boushey, R. P. (2009). Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg, 22(4), 191-197.
Heald, R. J., & Bussey, H. J. (1975). Clinical experiences at St. Mark's Hospital with multiple synchronous cancers of the colon and rectum. Dis Colon Rectum, 18(1), 6-10.
Herbey, II, Ivankova, N. V., Katkoori, V. R., & Mamaeva, O. A. (2005). Colorectal cancer and hypercholesterolemia: review of current research. Exp Oncol, 27(3), 166-178.
Hu, F. B., Manson, J. E., Liu, S., Hunter, D., Colditz, G. A., Michels, K. B., Speizer, F. E., & Giovannucci, E. (1999). Prospective study of adult onset diabetes mellitus (type 2) and risk of colorectal cancer in women. J Natl Cancer Inst, 91(6), 542-547.
Inoue, M., Noda, M., Kurahashi, N., Iwasaki, M., Sasazuki, S., Iso, H., & Tsugane, S. (2009). Impact of metabolic factors on subsequent cancer risk: results from a large-scale population-based cohort study in Japan. Eur J Cancer Prev, 18(3), 240-247.
Itzkowitz, S. H., & Yio, X. (2004). Inflammation and cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol Gastrointest Liver Physiol, 287(1), G7-17.
Jiang, Y. D., Chang, C. H., Tai, T. Y., Chen, J. F., & Chuang, L. M. (2012). Incidence and prevalence rates of diabetes mellitus in Taiwan: analysis of the 2000-2009 Nationwide Health Insurance database. J Formos Med Assoc, 111(11), 599-604.
Johnson, C. M., Wei, C., Ensor, J. E., Smolenski, D. J., Amos, C. I., Levin, B., & Berry, D. A.(2013). Meta-analyses of colorectal cancer risk factors. Cancer Causes Control, 24(6), 1207-1222.
Johnson, J. A., Carstensen, B., Witte, D., Bowker, S. L., Lipscombe, L., & Renehan, A. G. (2012). Diabetes and cancer (1): evaluating the temporal relationship between type 2 diabetes and cancer incidence. Diabetologia, 55(6), 1607-1618.
Kabat, G. C., Kim, M. Y., Peters, U., Stefanick, M., Hou, L., Wactawski-Wende, J., Messina, C., Shikany, J. M., & Rohan, T. E. (2012). A longitudinal study of the metabolic syndrome and risk of colorectal cancer in postmenopausal women. Eur J Cancer Prev, 21(4), 326-332.
Kanazawa, T., Watanabe, T., & Nagawa, H. (2003). Does early polypoid colorectal cancer with depression have a pathway other than adenoma-carcinoma sequence? Tumori, 89(4), 408-411.
Kim, Y. J., Kim, E. H., & Hahm, K. B. (2012). Oxidative stress in inflammation-based gastrointestinal tract diseases: challenges and opportunities. J Gastroenterol Hepatol, 27(6), 1004-1010.
Kinney, A. Y., Hicken, B., Simonsen, S. E., Venne, V., Lowstuter, K., Balzotti, J., & Burt, R. W. (2007). Colorectal cancer surveillance behaviors among members of typical and attenuated FAP families. Am J Gastroenterol, 102(1), 153-162.
Kitahara, C. M., Berrington de Gonzalez, A., Freedman, N. D., Huxley, R., Mok, Y., Jee, S. H., & Samet, J. M. (2011). Total cholesterol and cancer risk in a large prospective study in Korea. J Clin Oncol, 29(12), 1592-1598.
La Vecchia, C., Negri, E., Decarli, A., & Franceschi, S. (1997). Diabetes mellitus and colorectal cancer risk. Cancer Epidemiol Biomarkers Prev, 6(12), 1007-1010.
Larsson, S. C., Orsini, N., & Wolk, A. (2005). Diabetes mellitus and risk of colorectal cancer: a meta-analysis. J Natl Cancer Inst, 97(22), 1679-1687.
Le Marchand, L., Wilkens, L. R., Kolonel, L. N., Hankin, J. H., & Lyu, L. C. (1997). Associations of sedentary lifestyle, obesity, smoking, alcohol use, and diabetes with the risk of colorectal cancer. Cancer Res, 57(21), 4787-4794.
Lee, M. H., Kim, H. C., Ahn, S. V., Hur, N. W., Choi, D. P., Park, C. G., & Suh, I. (2012). Prevalence of Dyslipidemia among Korean Adults: Korea National Health and Nutrition Survey 1998-2005. Diabetes Metab J, 36(1), 43-55.
Lee, M. Y., Lin, K. D., Hsiao, P. J., & Shin, S. J. (2012). The association of diabetes mellitus with liver, colon, lung, and prostate cancer is independent of hypertension, hyperlipidemia, and gout in Taiwanese patients. Metabolism, 61(2), 242-249.
Limburg, P. J., Anderson, K. E., Johnson, T. W., Jacobs, D. R. Jr., Lazovich, D., Hong, C. P., Nicodemus, K. K., & Folsom, A. R. (2005). Diabetes mellitus and subsite- specific colorectal cancer risks in the Iowa Women's Health Study. Cancer Epidemiol Biomarkers Prev, 14(1), 133-137.
Lin, J. H., Giovannucci, E.(2010). Sex hormones and colorectal cancer: what have we learned so far? J Natl Cancer Inst, 102(23), 1746-7.
Lin, J. H., Zhang, S. M., Rexrode, K. M., Manson, J. E., Chan, A. T., Wu, K., Tworoger, S. S., Hankinson, S. E., Fuchs, C., Gaziano, J. M., Buring, J. E., & Giovannucci, E. (2013). Association between sex hormones and colorectal cancer risk in men and women. Clin Gastroenterol Hepatol, 11(4), 419-424.
Luo, J., Chlebowski, R., Liu, S., McGlynn, K. A., Parekh, N., White, D. L., & Margolis, K. L. (2013). Diabetes mellitus as a risk factor for gastrointestinal cancers among postmenopausal women. Cancer Causes Control, 24(3), 577-585.
Luo, S., Li, J. Y., Zhao, L. N., Yu, T., Zhong, W., Xia, Z. S., Shan, T. D., Ouyang, H., Yang, H. S., & Chen, Q. K. (2016). Diabetes mellitus increases the risk of colorectal neoplasia: An updated meta-analysis. Clin Res Hepatol Gastroenterol, 40(1), 110-123.
Marshall, J. R. (2008). Prevention of colorectal cancer: diet, chemoprevention, and lifestyle. Gastroenterol Clin North Am, 37(1), 73-82, vi.
McKeown-Eyssen, G. (1994). Epidemiology of colorectal cancer revisited: are serum triglycerides and/or plasma glucose associated with risk? Cancer Epidemiol Biomarkers Prev, 3(8), 687-695.
Mills, K. T., Bundy, J. D., Kelly, T. N., Reed, J. E., Kearney, P. M., Reynolds, K., Chen, J., & He, J. (2016). Global Disparities of Hypertension Prevalence and Control: A systematic analysis of population-based studies from 90 countries. Circulation, 134(6), 441-450.
Moghaddam, A. A., Woodward, M., & Huxley, R. (2007). Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomarkers Prev, 16(12), 2533-2547.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., de Ferranti, S., Despres, J. P., Fullerton, H. J., Howard, V. J., Huffman, M. D., Judd, S. E., Kissela, B. M., Lackland, D. T., Lichtman, J. H., Lisabeth, L. D., Liu, S., Mackey, R. H., Matchar, D. B., McGuire, D. K., Mohler, E. R., Moy, C. S., Muntner, P., Mussolino, M. E., Nasir, K., Neumar, R. W., Nichol, G., Palaniappan, L., Pandey, D. K., Reeves, M. J., Rodriguez, C. J., Sorlie, P. D., Stein, J., Towfighi, A., Turan, T. N., Virani, S. S., Willey, J. Z., Woo, D., Yeh, R. W., & Turner, M. B. (2015). Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation, 131(4), e29-322.
Ng, S.C., Wong, S.H. (2013). Colorectal cancer screening in Asia. Br. Med. Bull, 105(1), 29–42.
Ogunleye, A. A., Ogston, S. A., Morris, A. D., & Evans, J. M. (2009). A cohort study of the risk of cancer associated with type 2 diabetes. Br J Cancer, 101(7), 1199-1201.
Parhofer, K. G. (2015). Interaction between Glucose and Lipid Metabolism: More than Diabetic Dyslipidemia. Diabetes Metab J, 39(5), 352-362.
Pelucchi, C., Negri, E., Talamini, R., Levi, F., Giacosa, A., Crispo, A., Bidoli, E., Montella, M., Franceschi, S., & La Vecchia, C. (2010). Metabolic syndrome is associated with colorectal cancer in men. Eur J Cancer, 46(10), 1866-1872.
Rosato, V., Tavani, A., Gracia-Lavedan, E., Guino, E., Castano-Vinyals, G., Villanueva, C. M., Kogevinas, M., Polesel, J., Serraino, D., Pisa, F. E., Barbone, F., Moreno, V., La Vecchia, C., & Bosetti, C. (2016). Type 2 diabetes, antidiabetic medications, and colorectal cancer risk: Two case-control studies from Italy and Spain. Front Oncol, 6(1), 210-217.
Slattery, M. L., Sweeney, C., Murtaugh, M., Ma, K. N., Wolff, R. K., Potter, J. D., Caan, B. J., & Samowitz, W. (2005). Associations between ERalpha, ERbeta, and AR genotypes and colon and rectal cancer. Cancer Epidemiol Biomarkers Prev, 14(12), 2936-42.
Sowers, J. R., Khoury, S., Standley, P., Zemel, P., & Zemel, M.(1991). Mechanisms of hypertension in diabetes. Am J Hypertens,4(2 Pt 1), 177-182.
Stocks, T., Lukanova, A., Bjorge, T., Ulmer, H., Manjer, J., Almquist, M., Concin, H., Engeland, A., Hallmans, G., Nagel, G., Tretli, S., Veierod, M. B., Jonsson, H., & Stattin, P. (2011). Metabolic factors and the risk of colorectal cancer in 580,000 men and women in the metabolic syndrome and cancer project (Me-Can). Cancer, 117(11), 2398-2407.
Stocks, T., Lukanova, A., Johansson, M., Rinaldi, S., Palmqvist, R., Hallmans, G., Kaaks, R., & Stattin, P. (2008). Components of the metabolic syndrome and colorectal cancer risk; a prospective study. Int J Obes (Lond), 32(2), 304-314.
Stocks, T., Van Hemelrijck, M., Manjer, J., Bjorge, T., Ulmer, H., Hallmans, G., Lindkvist, B., Selmer, R., Nagel, G., Tretli, S., Concin, H., Engeland, A., Jonsson, H., & Stattin, P. (2012). Blood pressure and risk of cancer incidence and mortality in the Metabolic Syndrome and Cancer Project. Hypertension, 59(4), 802-810.
Suh, S., & Kim, K. W. (2011). Diabetes and cancer: is diabetes causally related to cancer? Diabetes Metab J, 35(3), 193-198.
Sun, Z. J., Huang, Y. H., Wu, J. S., Yang, Y. C., Chang, Y. F., & Lu, F. H. (2011). The association of serum lipids with the histological pattern of rectosigmoid adenoma in Taiwanese adults. BMC Gastroenterol, 11(1), 54-62.
Sung, J. J., Lau, J. Y., Goh, K. L., & Leung, W. K. (2005). Increasing incidence of colorectal cancer in Asia: implications for screening. Lancet Oncol, 6(11), 871-876.
Takahashi, H., Yoneda, K., Tomimoto, A., Endo, H., Fujisawa, T., Iida, H., Mawatari, H., Nozaki, Y., Ikeda, T., Akiyama, T., Yoneda, M., Inamori, M., Abe, Y., Saito, S., Nakajima, A., & Nakagama, H. (2007). Life style-related diseases of the digestive system: colorectal cancer as a life style-related disease: from carcinogenesis to medical treatment. J Pharmacol Sci, 105(2), 129-132.
Terry, M. B., Neugut, A. I., Bostick, R. M., Sandler, R. S., Haile, R. W., Jacobson, J. S., Fenoglio-Preiser, C. M., & Potter, J. D. (2002). Risk factors for advanced colorectal adenomas: a pooled analysis. Cancer Epidemiol Biomarkers Prev, 11(7), 622-9.
Terry, P., Ekbom, A., Lichtenstein, P., Feychting, M., & Wolk, A.(2001). Long-term tobacco smoking and colorectal cancer in a prospective cohort study. Int J Cancer, 91(4), 585-587.
Terry, P. D., Miller, A. B., & Rohan, T. E. (2002). Obesity and colorectal cancer risk in women. Gut, 51(2), 191-194.
Toyota, M., Ohe-Toyota, M., Ahuja, N., & Issa, J. P. (2000). Distinct genetic profiles in colorectal tumors with or without the CpG island methylator phenotype. Proc Natl Acad Sci U S A, 97(2), 710-715.
Tsushima, M., Nomura, A. M., Lee, J., & Stemmermann, G. N. (2005). Prospective study of the association of serum triglyceride and glucose with colorectal cancer. Dig Dis Sci, 50(3), 499-505.
van Duijnhoven, F. J., Bueno-De-Mesquita, H. B., Calligaro, M., Jenab, M., Pischon, T., Jansen, E. H., Frohlich, J., Ayyobi, A., Overvad, K., Toft-Petersen, A. P., Tjonneland, A., Hansen, L., Boutron-Ruault, M. C., Clavel-Chapelon, F., Cottet, V., Palli, D., Tagliabue, G., Panico, S., Tumino, R., Vineis, P., Kaaks, R., Teucher, B., Boeing, H., Drogan, D., Trichopoulou, A., Lagiou, P., Dilis, V., Peeters, P. H., Siersema, P. D., Rodriguez, L., Gonzalez, C. A., Molina-Montes, E., Dorronsoro, M., Tormo, M. J., Barricarte, A., Palmqvist, R., Hallmans, G., Khaw, K. T., Tsilidis, K. K., Crowe, F. L., Chajes, V., Fedirko, V., Rinaldi, S., Norat, T., & Riboli, E. (2011). Blood lipid and lipoprotein concentrations and colorectal cancer risk in the European Prospective Investigation into Cancer and Nutrition. Gut, 60(8), 1094-1102.
Vigneri, P., Frasca, F., Sciacca, L., Pandini, G., & Vigneri, R. (2009). Diabetes and cancer. Endocr-Relat Cancer, 16(4), 1103-1123.
Virdis, A., Giannarelli, C., Neves, M. F., Taddei, S., & Ghiadoni, L.(2010). Cigarette smoking and hypertension. Curr Pharm Des, 16(23), 2518-2525.
Wang, J. Y., Chao, T. T., Lai, C. C., Wang, C. Y., Wu, V. C., Wang, S. M., Lin, H. I., Tang, S. H., & Lin, H. W. (2013). Risk of colorectal cancer in type 2 diabetic patients: a population-based cohort study. Jpn J Clin Oncol, 43(3), 258-263.
Will, J. C., Galuska, D. A., Vinicor, F., & Calle, E. E. (1998). Colorectal cancer: another complication of diabetes mellitus? Am J Epidemiol, 147(9), 816-825.
Yao, X., & Tian, Z. (2015). Dyslipidemia and colorectal cancer risk: a meta-analysis of prospective studies. Cancer Causes Control, 26(2), 257-268.
Yood, M. U., Oliveria, S. A., Campbell, U. B., & Koro, C. E. (2009). Incidence of cancer in a population-based cohort of patients with type 2 diabetes. Diabetes Metab Syndr,3(1):12-16.
Yuhara, H., Steinmaus, C., Cohen, S. E., Corley, D. A., Tei, Y., & Buffler, P. A. (2011). Is diabetes mellitus an independent risk factor for colon cancer and rectal cancer? Am J Gastroenterol, 106(11), 1911-1921.
 
二、中文參考文獻
世界衛生組織 (World Health Organization, WHO) 網址http://www.who.int/en/。
香港醫院管理局癌症資料統計中心網站http://www3.ha.org.hk/cancereg/tc/。
美國國家癌症研究所(National Cancer Institute, NCI)網站 https://www.cancer.gov/。
衛生福利部網站http://www.mohw.gov.tw/mp-1.html。
國民健康署網站https://www.hpa.gov.tw/home/index.aspx。
國際糖尿病聯盟(International Diabetes Federation, IDF)網站https://www.idf.org/。
張簡俊榮. (2008). 台灣大腸直腸癌的流行病學. [Epidemiology of Colorectal Cancer in Taiwan]. 中華民國癌症醫學會雜誌, 24(3), 143-147.