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研究生:游淑蓉
研究生(外文):YU, SHU-JUNG
論文名稱:探討乳癌病人手術中放射線治療及手術後體外放射線治療 之存活與復發情形
論文名稱(外文):Probe survival rate and recurrence of intraoperative radiation therapy and postoperative external beam radiation therapy on treating breast cancer
指導教授:翁世峰
指導教授(外文):WENG, SHIH-FENG
口試委員:黃昱瞳黃志仁
口試委員(外文):HUANG, YU-TUNGHUANG, CHIH-JEN
口試日期:2021-06-10
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:醫務管理暨醫療資訊學系碩士在職專班
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:2021
畢業學年度:109
語文別:中文
論文頁數:105
中文關鍵詞:早期乳癌手術中放射線治療手術後體外放射線治療存活復發
外文關鍵詞:early stage breast cancerIORTEBRTsurvivalrecurrence
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研究目的
女性乳癌已蟬聯台灣女性癌症發生率首位多年,且有逐年增加的趨勢。國外研究顯示,接受乳房保留手術中放射線治療的病人,其存活與復發情形不盡相同,因此期望藉此研究了解接受乳房保留手術中放射線治療或手術後體外放射線治療病人之存活及復發情形。
研究方法
本研究為回溯性的世代追蹤研究資料分析,利用南區某醫學中心及區域醫院之癌症登記資料庫分析,納入條件為2014-2018年診斷早期乳癌且以手術為首次療程並接受手術中放射線治療或手術後體外放射線治療資料,依兩組病人之臨床特性以傾向分數配對,以降低觀察性研究中干擾因子所造成的偏差,使用SPSS 20版套裝軟體進行研究假設驗證。
研究結果
經過傾向分數配對後,手術中放射線治療與手術後體外放射線治療兩組個案數各為412名,短期整體復發率及短期局部復發率兩組比較未達統計上顯著差異,長期整體復發率與長期局部復發率兩組比較,手術中放射治療組皆高於手術後體外放射線治療,且具統計上顯著差異,而長、短期整體存活率及長、短期乳癌相關性存活率皆未達統計上顯著差異。
結論與建議
本研究顯示,早期乳癌接受保留手術後,合併手術中放射線治療或手術後體外放射線治療對長期存活情形無明顯影響,但會影響長期復發情形,透過本研究結果,可了解早期乳癌病人接受乳房保留手術合併手術中放射線治療之治療品質,及後續治療規劃,也可提供給臨床醫療與病人於治療決策時的參考。

Purpose
Breast cancer has been the most common in Taiwanese women for many years, and the number is increasing year by year. Studies conducted by foreign organizations have been shown that patients doing radiation therapy during surgery obtains different survival rate and the risk of recurrence. It is a trigger to do the study for learning if the rate of survival and recurrence is showing noticeable difference on patients who were treated by Intraoperative radiotherapy (IORT) or external beam
Radiotherapy (EBRT).
Materials & Method
This research is using retrospective cohort study by analyzing secondary data from cancer registration data base in an anonymous medical center and regional hospital in Southern Taiwan. Patients diagnosed with early stage breast cancer and chose operation as first course of treatment, in the mean time, accepting IORT or EBRT were selected in this study. According to clinical manifestation in these two groups of patients, propensity score matching is used to minimize the deviation derived from confounders in observational study.
Results
Under propensity score matching, there are 412 cases in each group, IORT and EBRT. The difference is not statistically significant on overall and local reoccurrence rate under short-term observation; however, it shows IORT is higher than EBRT with notable statistically difference under long-term observation. Another two results have been included in this research, overall survival rate and breast cancer related survival rate under short-term and long-term observation and they show no memorable discrepancy.
Conclusion
The study shows recurrence can be affected no matter accepting IORT or EBRT on early stage breast cancer patients conducted BCS, but no significant difference on long-term survival rate. Through this study, not only can understand the treatment quality from conducting IORT and EBRT but also provide a reference when choosing a suitable treatment for clinical medicine and patients.

致謝 I
中文摘要 II
ABSTRACT III
目錄 V
圖目錄 VI
表目錄 VII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第三節 預期貢獻 3
第二章 文獻探討 4
第一節 乳癌概論 4
第二節 乳癌的治療現況 8
第三節 放射線治療概論 11
第四節 乳癌及放射線治療相關研究 15
第五節 傾向分數配對之應用 22
第六節 文獻小結 24
第三章 研究方法 25
第一節 研究架構與研究設計 25
第二節 研究假說 27
第三節 資料來源與研究樣本 28
第四節 研究變項說明 32
第五節 資料蒐集處理與統計方法 41
第四章 研究結果 42
第一節 描述性統計分析 42
第二節 手術中放射線治療或手術後體外放射線治療之長、短期整體復發 與局部復發情形及其相關危險因子 54
第三節 手術中放射線治療或手術後體外放射線治療之整體存活與 乳癌特異性存活情形及其相關危險因子 72
第五章 討論與結論 85
第一節 手術中放射線治療或手術後體外放射線治療之長、短期乳癌整體復發 與局部復發情形討論 85
第二節 手術中放射線治療或手術後體外放射線治療之長、短期整體存活 與乳癌特異性存活情形及其相關危險因子討論 89
第三節 研究限制與未來方向 91
第四節 結論與建議 92
參考文獻 93

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