肺癌合併多重原發性癌之存活丶危險因子與醫療費用分析：台灣健保資料庫研究_

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題名：	肺癌合併多重原發性癌之存活丶危險因子與醫療費用分析：台灣健保資料庫研究
作者：	周紋如
作者(外文)：	WEN-RU CHOU
校院名稱：	輔仁大學
系所名稱：	商學研究所博士班
指導教授：	謝邦昌陳銘芷
學位類別：	博士
出版日期：	2023
主題關鍵詞：	肺癌；多重原發性癌；存活；危險因子；表皮生長因子受體；酪胺酸激酶抑制劑；醫療費用；台灣全民健康保險研究資料庫；台灣癌症登記資料庫；lung cancer；multiple primary malignancies (MPMs)；survival；risk factors；epidermal growth factor receptor (EGFR)；tyrosine kinase inhibitor (TKI)；expenditure；National Health Insurance Registry Database (NHIRD)；Taiwan Cancer Registry (TCR)
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:0 共同引用:0 點閱:1

隨著生存壽命的增加，癌症患者發生多重原發性癌的風險也隨之增加。過去研究發現，多重原發性癌 (multiple primary malignancies, MPMs) 的發生率有逐漸增加的趨勢，也因此這個議題愈來愈受專家及學者重視。近來，愈來愈多的研究探討多重原發性癌症的發生率丶危險因子及存活率，但研究結果仍然存在極大的差異性，此外，過去相關研究多為單一中心或區域性癌症登記資料分析，基於此，需要全國性的資料庫進行全面分析。本研究的目的在探討肺癌合併第二原發性癌 (在本文亦稱為「肺癌先發」(lung cancer first , LCF)) 的存活狀況、危險因子以及相關醫療費用。研究方法：本研究使用台灣全民健康保險研究資料庫及台灣癌症登記資料庫進行回溯性研究。納入了2011年1月1日至2016年12月31日之肺癌患者，往前追溯到2002年1月1日，往後追蹤到2019年12月31日，以確定是否先前已存在初始原發性癌或之後發生第二原發性癌。結果：72,219例肺癌患者中，共有10,577例 (14.65%) 患者被診斷為多重原發性癌，肺癌先發 (lung cancer first, LCF) 和其他癌症先發 (other cancer first, OCF) 分別佔35.55%和64.45%。LCF患者中的患有同時多重原發性癌病患比例較高，佔65.33%。LCF最常合併的第二原發性癌是肺癌、大腸癌、乳癌及攝護腺癌。LCF患者的整體平均存活期長於單一肺癌 (single lung cancer) 患者。在單一肺癌和LCF組中，具有epidermal growth factor receptor (EGFR) 突變的晚期肺癌病患的存活率優於未檢測到EGFR突變的肺癌病患。在第III期及第Ⅳ期，不論是具EGFR突變或未檢測到EGFR突變，LCF組的存活率均優於單一肺癌。在排除一年內死亡的肺癌病患後，我們進一步分析肺癌患者發生第二原發性癌的危險因子，並通過Cox PH regression模型確定基本特徵、共病症和肺癌各種治療對發生第二原發性癌的風險。結果顯示高齡、男性、吸菸、早期肺癌、鱗狀細胞肺癌、小細胞肺癌、高血壓、糖尿病發生第二原發性癌的風險較高；接受手術、化學治療、放射治療和EGFR Tyrosine Kinase Inhibitor (TKI) 標靶治療的風險較低。最後我們針對肺癌死亡的病患進行醫療費用分析，並探討影響醫療費用的因素。結果顯示住院天數 (單一肺癌：86.92天；LCF：98.46天，p < 0.001)，門診就診總次數 (單一肺癌：337次；LCF：379次，p < 0.001)，住院總次數 (單一肺癌：11次；LCF：12次，p < 0.001)，總存活期 (單一肺癌：2.42年；LCF：2.87年，p < 0.001)，門診總費用 (單一肺癌：NTD 1,094,579；LCF：NTD 1,157,098，p < 0.001) 和住院總費用 (單一肺癌：NTD 673,657；LCF：NTD 805,165，p < 0.001) 均有顯著差異。結論：依據我們的研究結果，建議針對第二原發性癌高風險族群，包括高齡、男性、吸菸、早期肺癌、鱗狀細胞肺癌、小細胞肺癌、高血壓、糖尿病，於肺癌診斷時或診斷六個月內積極進行肺部及全身其他癌症之篩檢，尤其是肺癌最常合併的第二原發性癌，包括肺癌、大腸癌、乳癌及攝護腺癌。我們的研究結果有助於精準醫學的發展，藉以可以建立更好的個人化治療及存活預測，同時藉由我們的研究結果建立預測模型來評估第二原發性癌的危險因子，最後，透過早期肺癌篩檢和干預，降低肺癌合併第二原發性癌的死亡率及相關醫療費用。

以文找文

Cancer patients with longer lifespans are at risk of developing second primary malignancies. Studies show the incidence of multiple primary malignancies (MPMs) has increased, so it is important to conduct a thorough analysis based on the data from multiple hospitals and institutions to investigate the incidence, characteristics and risk factors of MPMs involving lung cancer. The aims of this research are to investigate the survival of lung cancer with second primary cancer (termed “lung cancer first (LCF)”), the risk factors of developing second primary cancers (SPCs) and the medical expenditure related to second primary cancers. Methods: A retrospective study was conducted based on Taiwan Cancer Database in Taiwan’s National Health Insurance Registry Database (NHIRD). Lung cancer patients from January 1, 2011, to December 31, 2016, were included and the study patients were traced back to January 1, 2002, and followed till December 31, 2019, to identify the existing or subsequent primary cancer. Results: Among 72,219 lung cancer patients, a total of 10,577 (14.65%) patients were diagnosed with MPMs, and the lung cancer first group (LCF) and other cancer first group (OCF) accounted for 35.55% and 64.45%, respectively. The LCF group had the highest proportion (65.33%) of patients with synchronous multiple primary malignancies (SMPMs). The four most common cancers after the initial lung cancer were lung, colon, breast and prostate cancers. The overall mean survival time of LCF patients was longer than that of single lung cancer patients. In both single lung cancer and LCF groups, survival in advanced lung cancer with mutant EGFR was superior to that in lung cancer with undetected EGFR. Survival in the LCF group was better than that in single lung cancer in stages Ⅲ and Ⅳ in both EGFR mutant and undetected. After excluding lung cancer deaths within one year, we investigated the risk factors for second primary cancers in patients with initial lung cancer and identified the impacts of baseline characteristics and treatments on the development of SPCs by Cox PH regression models. The results show increased hazard ratios for old age, male, smoking, early stage lung cancer, squamous cell lung cancer, small cell lung cancer, hypertension, and diabetes mellitus. Patients undergoing surgery, chemotherapy, and radiotherapy were associated with a lower risk of SPCs. Treatment with EGFR TKIs was a significant and independent factor associated with lower incidence of SPCs. Finally, we analyzed the medical expenditure and investigated the factors affecting the medical expenditure. Length of stay (single lung cancer: 86.92 days vs. LCF: 98.46 days; p < 0.001), total number of outpatient visits (single lung cancer: 337 vs. LCF: 379; p < 0.001), total number of inpatients (single lung cancer: 11 vs. LCF: 12; p < 0.001) , total survival years (single lung cancer: 2.42 vs. LCF: 2.87; p < 0.001), total expenditure of outpatient visits (single lung cancer: NTD 1,094,579 vs. LCF: NTD 1,157,098; p < 0.001) and total expenditure of inpatients (single lung cancer: NTD 673,657 vs. LCF: NTD 805,165; p < 0.001) were all significantly different. Conclusions: Our findings can contribute to the development of precision medicine, which will lead to better personalized treatments, survival prediction and encourage researchers to establish predictive models based on our results to assess the risk factors for SPCs, and therefore, early screening and intervention could be applied, and the SPCs-related mortality and relevant medical expenditure could be reduced.

以文找文

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