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研究生:查利璇
研究生(外文):LI HSIEN CHA
論文名稱:臺灣晚期卵巢癌病人施打Platinum併用 Paclitaxel化療處方總療程天數對療效之分析
論文名稱(外文):Evaluation therapeutic efficacy of the Duration by using Platinum combined paclitaxel regimen on Survival in Patients with advanced ovarian cancer patients in Taiwan
指導教授:湯澡薫
指導教授(外文):Chao-Hsiun Tang
口試委員:鄭文芳楊哲銘
口試委員(外文):Wen-Fang ChengChe-Ming Yang
口試日期:2019-06-27
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:醫務管理學系碩士在職專班
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2019
畢業學年度:107
語文別:中文
論文頁數:71
中文關鍵詞:晚期卵巢癌、總療程天數延長、整體存活
外文關鍵詞:Advanced ovarian cancer、Chemotherapy delays、 Overall survival
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卵巢癌是一種常見的婦科惡性腫瘤,常在診斷時已是晚期,且在治療上仍具挑戰;其中血液毒性和神經系統的併發症是platinum併用Paclitaxel化療處方常見的副作用。本研究的目的是評估platinum併用Paclitaxel化療處方總療程天數延長對晚期卵巢癌患者的整體存活率的影響,依據療程次數與總療程天數共分為四組:施打6次Platinum 藥物合併 Paclitaxel 化療處方,且總療程天數為105天至115天、施打6次Platinum 藥物合併 Paclitaxel 化療處方,且總療程天數為116天至200天、施打7到9次Platinum 藥物合併 Paclitaxel 化療處方,且總療程天數為105天至170天和施打7到9次Platinum 藥物合併 Paclitaxel 化療處方,且總療程天數為171天至200天,進行整體存活率之比較。本研究利用全民健保資料庫中的癌症特殊需求檔為資料來源,以 Kaplan Meier survival curve來呈現存活曲線,並以 Cox proportion hazard model 計算接受不同化療處方的死亡危險性。研究結果顯示,在 2272 位納入本研究的對象中,在兩年整體存活率中,施打7到9次Platinum 藥物合併 Paclitaxel 化療處方,總療程天數為171天至200天之個案的死亡危險性為總療程天數為105天至170天之個案的1.77 倍 (95% CI:1.04-3.02, P = 0.036);在五年整體存活率中,施打7到9次Platinum 藥物合 Paclitaxel 化療處方,總療程天數為171天至200天之個案的死亡危險性為總療程天數為105天至170天之個案的1.54 倍 (95% CI : 1.04-2.28, P =0.033)。根據本研究的結果,建議若預計施打7到9次Platinum 藥物合 Paclitaxel 化療處方的晚期卵巢癌患者,於170天內完成總療程,以降低死亡率。
INTRODUCTION: Ovarian cancer is a common gynaecological malignancy and still remaining a challenge to treat. Hematologic and neurologic complications are common side effects of the platinum and taxane-based chemotherapy used in the primary treatment of epithelial ovarian cancer. The objective of this study was to evaluate the impact of platinum combined paclitaxel regimens delays on overall survival in patients with advanced ovarian cancer patients in Taiwan.
METHODS: Retrospective analysis by using 2000-2013 National Health Insurance Research Database (NHIRD). Inclusion criteria were advanced stage disease and first line chemotherapy with a 6-9 courses platinum combined paclitaxel regimen within 60 days after the surgery. Excluding treatment day small then 105 or over 200 days. Overall survival were analyzed using Kaplan-Meier and Cox proportional hazards models.
RESULTS: 2272 patients met the inclusion criteria. Patients were divided into four groups: 6 courses platinum + paclitaxel regimen, with 105 to 115 treatment days, 6 courses platinum + paclitaxel regimen, with 116 to 200 treatment days, 7-9 courses platinum + paclitaxel regimen, with 105 to 170 treatment days, and 7-9 courses platinum + paclitaxel regimen, with 171 to 200 treatment days. Significant 1.54 times higher death risk in patients who experienced 7-9 courses platinum + paclitaxel regimen, with 171 to 200 treatment days compared with patients who experienced 7-9 courses platinum + paclitaxel regimen, with 105 to 170 treatment days (HR = 1.54, 95% Cl: 1.04-3.02, p = 0.033).
CONCLUSIONS : Chemotherapy delays in patients with advanced ovarian cancer caused lower overall survival.
致謝 I
摘要 III
Abstract IV
目錄 VI
表目次 VIII
圖目次 IX
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第三節 研究的重要性 6
第二章 文獻探討 7
第一節、卵巢癌定義與介紹 7
第二節、卵巢癌治療方式 11
第三節、Platinum合併Paclitaxel化療處方常見副作用 16
第四節、延長化療給藥週期之相關文獻探討 18
總結 20
第三章 研究方法 21
第一節、研究設計 21
第二節、研究架構 22
第三節、研究變項與操作型定義 24
第四節、研究對象與資料來源 31
第五節、研究假說 34
第六節、資料處理與統計方法 35
第四章 研究結果 37
第一節、研究對象基本特性分布情形 37
第二節、研究對象之存活狀況分析 44
第三節、多變項之分析結果 53
第五章 討論 56
第一節、研究結果討論 56
第二節、研究限制 57
第三節、研究結論 58
第四節、研究建議 59
參考文獻 60
中文部分 60
英文部分 61


表目次
頁碼
表11-1-1、臺灣 1979-2019 年「卵巢、輸卵管及寬韌帶癌」年齡標準化發生率及死亡率 3
表22-2-1、卵巢癌化學治療指引比較 15
表32-4-1、卵巢癌患者化學治療總療程時間延長對療效影響之相關文獻 - 19 -
表43-3-1、研究變項與其操作型定義 29
表54-1-1、總療程天數分佈概況 39
表64-1-2、總療程天數之病患特性分佈 40
表74-1-3、不同總療程天數之醫院特性分佈 43
表84-2-1、總療程天數之整體存活分析 46
表94-2-2、施打6次療程總天數之整體存活分析結果 51
表104-2-3、施打7到9次療程總天數之整體存活分析結果 52
表114-3-1、施打6次療程天數之整體存活多變項分析結果 54
表124-3 2、施打7到9次療程天數之整體存活多變項分析結果 55


圖目次

頁碼
圖12-1-1、臺灣地區 1979-2016 年間「卵巢癌、輸卵管癌及寬韌帶癌」標準化發生率長期趨勢。 2
圖33-2-1、本研究之研究架構圖。 23
圖43-3-1、整體存活率2年 (5年)觀察示意圖。 25
圖53-4-1、本研究對象篩選流程圖。 33
圖64-2-1、施打6次 Platinum 藥物合併 Paclitaxel 化療處方兩年整體存活之存活曲線圖。 48
圖74-2 2、施打6次 Platinum 藥物合併 Paclitaxel 化療處方五年整體存活之存活曲線圖。 48
圖84-2 3、施打7到9次Platinum 藥物合併 Paclitaxel 化療處方兩年整體存活之存活曲線圖。 49
圖94-2 4、施打7到9次Platinum 藥物合併 Paclitaxel 化療處方五年整體存活之存活曲線圖。 49
Bolis, G., Scarfone, G., Polverino, G., Raspagliesi, F., Tateo, S., Richiardi, G., . . . Presti, M. J. J. o. c. o. (2004). Paclitaxel 175 or 225 mg per meters squared with carboplatin in advanced ovarian cancer: a randomized trial. J Clin Oncol., 22(4), 686-690.
Chiang, Y.-C., Chen, C.-A., Chiang, C.-J., Hsu, T.-H., Lin, M.-C., You, S.-L., . . . Lai, M.-S. J. J. o. g. o. (2013). Trends in incidence and survival outcome of epithelial ovarian cancer: 30-year national population-based registry in Taiwan. J Gynecol Oncol, 24(4), 342-351.
Chu, E., & DeVita Jr, V. T. (2018). Physicians'' Cancer Chemotherapy Drug Manual 2019: Jones & Bartlett Learning.
Connelly, E., Markman, M., Kennedy, A., Webster, K., Kulp, B., Peterson, G., & Belinson, J. J. G. o. (1996). Paclitaxel delivered as a 3-hr infusion with cisplatin in patients with gynecologic cancers: unexpected incidence of neurotoxicity. Journal of the National Cancer Institute, 62(2), 166-168.
Du Bois, A., Lück, H.-J., Meier, W., Adams, H.-P., Mobus, V., Costa, S., . . . Schröder, W. J. J. o. t. N. C. I. (2003). A randomized clinical trial of cisplatin/paclitaxel versus carboplatin/paclitaxel as first-line treatment of ovarian cancer. Journal of the National Cancer Institute, 95(17), 1320-1329.
Fauci, J. M., Whitworth, J. M., Schneider, K. E., Subramaniam, A., Zhang, B., Frederick, P. J., . . . Straughn, J. M., Jr. (2011). Prognostic significance of the relative dose intensity of chemotherapy in primary treatment of epithelial ovarian cancer. Gynecol Oncol, 122(3), 532-535. doi:10.1016/j.ygyno.2011.05.023
Gates, M. A., Rosner, B. A., Hecht, J. L., & Tworoger, S. S. J. A. j. o. e. (2009). Risk factors for epithelial ovarian cancer by histologic subtype. Am J Epidemiol., 171(1), 45-53.
Hanna, R. K., Poniewierski, M. S., Laskey, R. A., Lopez, M. A., Shafer, A., Van Le, L., . . . Secord, A. A. J. G. o. (2013). Predictors of reduced relative dose intensity and its relationship to mortality in women receiving multi-agent chemotherapy for epithelial ovarian cancer. GYNECOLOGIC ONCOLOGY, 129(1), 74-80.
Hendrayana, T., Wilmer, A., Kurth, V., Schmidt-Wolf, I. G., & Jaehde, U. J. S. p. (2017). Anticancer dose adjustment for patients with renal and hepatic dysfunction: from scientific evidence to clinical application. Sci. Pharm., 85(1), 8.
Herrinton, L. J., Stanford, J. L., Schwartz, S. M., & Weiss, N. S. (1994). Ovarian cancer incidence among Asian migrants to the United States and their descendants. JNCI: Journal of the National Cancer Institute, 86(17), 1336-1339.
Huang, Y.-W., Kuo, C.-T., Stoner, K., Huang, T. H.-Y., & Wang, L.-S. (2011). An overview of epigenetics and chemoprevention. FEBS letters, 585(13), 2129-2136.
International, C. O. N. G. J. L. (2002). Paclitaxel plus carboplatin versus standard chemotherapy with either single-agent carboplatin or cyclophosphamide, doxorubicin, and cisplatin in women with ovarian cancer: the ICON3 randomised trial. Lancet, 360(9332), 505.
Kauff, N. D., Mitra, N., Robson, M. E., Hurley, K. E., Chuai, S., Goldfrank, D., . . . Borgen, P. I. J. J. o. t. N. C. I. (2005). Risk of ovarian cancer in BRCA1 and BRCA2 mutation-negative hereditary breast cancer families. J Natl Cancer Inst., 97(18), 1382-1384.
Kliewer, E. V., & Smith, K. R. (1995). Ovarian cancer mortality among immigrants in Australia and Canada. Cancer Epidemiology and Prevention Biomarkers, 4(5), 453-458.
Liutkauskiene, S., Janciauskiene, R., Jureniene, K., Grizas, S., Malonyte, R., & Juozaityte, E. J. B. c. (2015). Retrospective analysis of the impact of platinum dose reduction and chemotherapy delays on the outcomes of stage III ovarian cancer patients. BMC Cancer, 15(1), 105.
Muggia, F. M., Braly, P. S., Brady, M. F., Sutton, G., Niemann, T. H., Lentz, S. L., . . . Small, J. M. J. J. o. C. O. (2000a). Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a gynecologic oncology group study. J Clin Oncol, 18(1), 106-106.
Muggia, F. M., Braly, P. S., Brady, M. F., Sutton, G., Niemann, T. H., Lentz, S. L., . . . Small, J. M. J. J. o. C. O. (2000b). Phase III randomized study of cisplatin versus paclitaxel versus cisplatin and paclitaxel in patients with suboptimal stage III or IV ovarian cancer: a gynecologic oncology group study. J Clin Oncol., 18(1), 106-106.
Nagel, C., Backes, F. J., Hade, E., Cohn, D., Eisenhauer, E., O''Malley, D. M., . . . Salani, R. J. G. o. (2012). Effect of chemotherapy delays and dose reductions on progression free and overall survival in the treatment of epithelial ovarian cancer. Gynecol Oncol, 124(2), 221-224.
Nayl, B., Durando, X., Pomel, C., Dubray, P., Mouret-Reynier, M., Le Bouedec, G., . . . Cure, H. J. J. o. C. O. (2009). Six versus nine cycles of paclitaxel-carboplatin as first-line chemotherapy in patients with newly diagnosed epithelial advanced ovarian cancer. Gynecologic Cancer, 27(15_suppl), e16535-e16535.
Olawaiye, A. B., Java, J. J., Krivak, T. C., Friedlander, M., Mutch, D. G., Glaser, G., . . . Lee, R. B. J. G. o. (2018). Does adjuvant chemotherapy dose modification have an impact on the outcome of patients diagnosed with advanced stage ovarian cancer? An NRG Oncology/Gynecologic Oncology Group study. GYNECOLOGIC ONCOLOGY, 151(1), 18-23.
Piccart, M., Bertelsen, K., Stuart, G., Cassidy, J., Mangioni, C., Simonsen, E., . . . Blom, R. J. I. J. o. G. C. (2003). Long‐term follow‐up confirms a survival advantage of the paclitaxel–cisplatin regimen over the cyclophosphamide–cisplatin combination in advanced ovarian cancer. Int J Gynecol Cancer, 13, 144-148.
Piccart, M. J., Bertelsen, K., James, K., Cassidy, J., Mangioni, C., Simonsen, E., . . . Blom, R. J. J. o. t. N. C. I. (2000). Randomized intergroup trial of cisplatin–paclitaxel versus cisplatin–cyclophosphamide in women with advanced epithelial ovarian cancer: three-year results. GYNECOLOGIC ONCOLOGY, 92(9), 699-708.
Reid, B. M., Permuth, J. B., & Sellers, T. A. (2017). Epidemiology of ovarian cancer: a review. Cancer biology & medicine, 14(1), 9.
Salehi, F., Dunfield, L., Phillips, K. P., Krewski, D., Vanderhyden, B. C. J. J. o. T., & Environmental Health, P. B. (2008). Risk factors for ovarian cancer: an overview with emphasis on hormonal factors. J Toxicol Environ Health B Crit Rev., 11(3-4), 301-321.
Sandercock, J., Parmar, M., Torri, V., & Qian, W. J. B. j. o. c. (2002). First-line treatment for advanced ovarian cancer: paclitaxel, platinum and the evidence. British Journal of Cancer, 87(8), 815.
Seebacher, V., Reinthaller, A., Koelbl, H., Concin, N., Nehoda, R., & Polterauer, S. (2017). The Impact of the Duration of Adjuvant Chemotherapy on Survival in Patients with Epithelial Ovarian Cancer - A Retrospective Study. PLoS One, 12(1), e0169272. doi:10.1371/journal.pone.0169272
Teng, Z., Han, R., Huang, X., Zhou, J., Yang, J., Luo, P., & Wu, M. (2016). Increase of incidence and mortality of ovarian cancer during 2003–2012 in Jiangsu Province, China. Frontiers in public health, 4, 146.
Torre, L. A., Trabert, B., DeSantis, C. E., Miller, K. D., Samimi, G., Runowicz, C. D., . . . Siegel, R. L. (2018). Ovarian cancer statistics, 2018. CA Cancer J Clin, 68(4), 284-296. doi:10.3322/caac.21456
Tsilidis, K., Allen, N., Key, T., Dossus, L., Lukanova, A., Bakken, K., . . . Hansen, L. J. B. j. o. c. (2011). Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer., 105(9), 1436.
Wei, K., Li, Y., Zheng, R., Zhang, S., Liang, Z., Cen, H., & Chen, W. (2015). Ovary cancer incidence and mortality in China, 2011. Chinese Journal of Cancer Research, 27(1), 38.
Whiteman, D. C., Murphy, M. F., Cook, L. S., Cramer, D. W., Hartge, P., Marchbanks, P. A., . . . Risch, H. A. J. J. o. t. N. C. I. (2000). Multiple births and risk of epithelial ovarian cancer. J Natl Cancer Inst., 92(14), 1172-1177.
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