臺灣博碩士論文加值系統

背景與目的
癌症是全球殺手，根據2013年美國癌症統計數據指出，結直腸癌(Colorectal Cancer，CRC) 發生率為全球癌症第三名，而在台灣，2014年台灣共有4.6萬人死於惡性腫瘤，其中，結直腸癌死亡人數為5603人，僅次於氣管、支氣管和肺癌、肝和肝內膽管癌，位於男女性癌症死亡率排名的第3位，發生率部分更是每年攀升，其中，50歲以下之年輕成人更以30-49歲結直腸癌的發生率呈現快速增加之趨勢，由2007年之1267人攀升至2014年1741人，增加近37%的人數，因此，本研究主要運用2007年至2016年健康檢查中心資料庫，探討我國50歲以下年輕成人結直腸腺瘤發生率及其十年趨勢以及危險因子。
研究方法
本研究運用2007年1月至西元2016年12月間，台北市某健康檢查中心大腸鏡檢查資料，採病例回顧方式進行年輕成人腺瘤發生率與危險因子之探討，將自變項部分包含年齡、性別、結直腸癌家族史、糖尿病、吸菸、飲酒、運動習慣及飲食型態是否吃素，以邏輯斯迴歸分析各自變項與腺瘤發生之相關性。
研究結果
不論年輕成人或50歲以上成人，2007年至2016年腺瘤發生率逐年上升，至2016年時，年輕成人結直腸腺瘤粗發生率高達每千人口141.4人，50歲以上成人結直腸腺瘤粗發生率高達每千人口259.2人。
危險因子部分，根據邏輯斯迴歸分析顯示，發生結直腸腺瘤之危險因子為年齡( ≥ 50歲)、男性、有糖尿病、吸菸、有運動習慣，年輕成人部分增加飲食型態為素食者，而危險因子部分除年齡外並無統計上顯著意義。
結論與建議
雖然危險因子部分僅有年齡( ≥ 50歲)有統計上顯著意義，但由2007年至2016年之發生率來看，不論年輕成人或50歲以上成人，腺瘤發生率均呈現上升趨勢，此結果可提供未來政策制定及臨床工作者參考。
關鍵詞：結直腸腺瘤、發生率、年輕成人、危險因子

Objectives
Cancer is a global killer. According to the American Cancer Statistics data 2013 , the incidence of Colorectal Cancer (CRC) is the third in the world. In Taiwan, 46,000 people died of malignant tumors in 2014; the mortality of colorectal cancer were 5,603 people. It's only less than the mortality of Trachea, Bronchus and Lung cancer, Liver and Intrahepatic cholangiocarcinoma, and ranks No. 3 in the male and female cancer mortality. And the incidence even increases year by year. The incidence related to young adults under 50 also showed a rapid increase. The incidence of colorectal cancer between the ages of 30 and 49, rising from 1,267 in 2007 to 1,741 in 2014, an increase of nearly 37%. Therefore, this study mainly based on the data of 2007 to 2016 Health Check Center intends to explore the incidence of colorectal adenoma in young adults under 50 and its ten-year trends and risk factors.
Methods
In this study, from January 2007 to December 2016, the Colonoscopy data from a health check center in Taipei City was collected. The incidence and risk factors of colorectal adenoma in young adults were retrospectively reviewed. The independent items included age, sex, family history of colorectal cancer, diabetes, smoking, drinking, exercise habits and dietary patterns(vegetarian or not?) were analyzed. Taking Logistic regression analysis, we analyzed the correlation between each independent item and the incidence of colorectal adenoma.
Results
The incidence of colorectal adenoma is increasing year by year from 2007 to 2016, whether young adults or adults over the age of 50. By 2016, the crude incidence of colorectal adenoma in young adults was as high as 141.4 persons in every thousand population. And the crude incidence of colorectal adenoma in adults over 50 was as high as 259.2 persons in every thousand population.
According to the logistic regression analysis, the risk factors can be shown as follows: the colorectal adenoma occurrence age (≥ 50 years old), male, with diabetes, smoking, with exercise habits, and the vegetarian diet type related to young adults.. The risk factors were not statistically significant except for the age.
Conclusions
Although the risk factors were only statistically significant for the age ( ≥ 50 years old) . The incidence of colorectal adenoma showed an upward trend from 2007 to 2016 in both young adults and adults over 50. This result can serve as references for policy makers and clinicians in the future.
Keywords: Colorectal adenoma, Incidence, young adults, risk factors

中文摘要 I
Abstract III
表目錄 VI
圖目錄 VII
第一章 緒論 1
第一節 研究背景 1
第二節 研究問題陳述 4
第三節 研究目的及研究問題與假設 5
第四節 研究之重要性 6
第二章 文獻探討 7
第一節 結直腸癌之流行病學 7
第二節 腺瘤與結直腸癌之危險因子 9
第三節 腺瘤與結直腸癌之相關研究 34
第四節 文獻總結 37
第三章 研究方法 38
第一節 研究架構 38
第二節 研究設計 39
第三節 研究對象及研究資料來源 39
第四節 研究變項之操作型定義 41
第五節 研究資料處理過程 44
第六節 統計分析方法 45
第四章 研究結果 46
第一節 研究個案之特性 46
第二節 結直腸腺瘤發生率及其分布情形 49
第三節 結直腸腺瘤與危險因子之相關性 55
第五章 討論與建議 58
第一節 研究結果總結與討論 59
第二節 研究之優點、限制及建議 60
第三節 研究結果之應用 61
參考文獻 62
(一) 中文部分 63
(二) 英文部分 64
附錄 90

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