| 摘要: | 背景與動機：膀胱癌為台灣地區常見的泌尿道腫瘤，可能因為存在著特殊的致癌因子如尿毒症、烏腳病等，死亡率雖不是很高，發生率卻頗高，所以膀胱癌的診斷及治療已是現代醫學及公共衛生上不可小看的問題。
目的：本研究目的為探討膀胱癌病患術後存活預後及死亡風險的預測因子，以為醫療處置的參考，提升癌症治療之醫療品質。
方法：資料來源為南台灣某醫學中心2010年至2015年之膀胱癌新診斷術後病患共有748人為研究世代。資料分析方法，首先以描述性統計呈現病患人口學特徵、癌症確認、TNM分期、病理檢驗結果與治療方式的分布情形，接著以推論性統計方法，包括卡方檢定、存活分析（Kaplan-Meier方法、Log-rank test），及Cox迴歸模型，探討膀胱癌病人存活預後及死亡風險之預測因子。本研究以Microsoft Excel 2016、SPSS 22.0進行資料整理與分析。
結果：研究樣本中，男性佔68.4%、第一次經尿道膀胱腫瘤切除手術以65歲以上最多（60.4%）、大多數人未抽菸（77.1%）、98.5%病人沒有接受腎移植手術，以及病人80.5%沒有罹患末期腎病變、88.5%術前?罹患上泌尿道上皮癌。Cox向前逐步迴歸模型，進行膀胱癌病患術後存活預後預測因子之相對重要性的分析，結果發現膀胱腫瘤切除年齡、血色素、嗜中性白血球、肌酐酸及癌症期別等，對病人之死亡風險有顯著影響。
結論：本研究主要目的是分析膀胱癌預後因子之探討；在單變量分析整體病患發現罹病年齡、末期腎病變、白血球、血色素、嗜中性白血球、淋巴球、血小板、肌酐酸、腫瘤侵犯程度、淋巴結是否轉移、遠端器官是否轉移、癌症期別、組織病理分級、是否侵犯肌肉層與治療方式等15項是影響膀胱癌病患術後存活預後的獨立預測因子。另外在多變量分析中發現罹病年齡、血色素、嗜中性白血球、肌酐酸及術後癌症期別為最主要的存活預後因子。因此根據本研究結果提出以下具體建議：1.加強國人對膀胱癌早期篩檢的重視，以期早期發現、早期治療，進而降低死亡風險，提升存活率。2.建議納入廣泛使用或常規使用之生化檢驗項目，包括血色素、嗜中性白血球、肌酐酸檢驗等項目，其檢驗結果可協助評估膀胱癌病人，做為臨床決策的重要參考依據。3.膀胱癌病人以手術切除併化療治療之術後存活預後比僅執行手術切除佳，建議臨床醫師完整評估存活預後的預測因子，提供個人化醫療，以提升癌症醫療品質。
Background and motivation: Bladder cancer is a common urinary tract cancer in Taiwan. There are special carcinogenic factors such as kidney dialysis, black foot disease, etc. although the mortality rate of bladder cancer is not very high. The incidence rate of bladder cancer is high, so the diagnosis and treatment can not be ignored on modern medicine and public health issues.
Objectives: The purpose of this study was to investigate the prognosis factors of postoperative survival and the risk factors of death in bladder cancer patients. The results could be a reference for medical treatment and improving the medical quality of cancer treatment.
Methods: The source of data is a total of 748 postoperative patients with newly diagnosed bladder cancer from 2010 to 2015 at a medical center in the south Taiwan. The descriptive statistics were used to present patient demographic characteristics, cancer confirmation, TNM stage, pathological test results, and the distribution of treatment methods. The inferential statistical methods include the Chi-square test, the Kaplan-Meier method, the Log-rank test, and the Cox regression model to investigate the predictors of survival prognosis of bladder cancer and the risk factors of death. This study uses Microsoft Excel 2016 and SPSS 22.0 to organize and analyze data.
Results: In the study sample, we got men accounted for 68.4%. The first transurethral resection of the bladder tumors was at most those were above 65 years old (60.4%). The most people were not smoking (77.1%), 98.5% of patients not received kidney transplants, and 80.5 %, 88.5% of patients not having end-stage renal disease, upper urinary tract urothelial carcinoma. The Cox forward stepwise regression model was used for analysis of the relative importance of the prognostic predictors of postoperative survival in patients with bladder cancer. The age of bladder tumor resection, hemoglobin, neutrophils, creatinine acid, and cancer stage, etc. were the significant risk factors of the mortality rate of patient.
Conclusions: This study was to investigate the prognostic factors of bladder cancer. In univariate analysis found the overall morbidity in patients age, end stage renal disease, white blood cells, hemoglobin, neutrophil (seg), lymphocyte, platelets, creatinine, the degree of tumor invasion, lymph node metastasis, whether distant organs metastasis, cancer of stage, histological grade, whether the muscle layer is invaded and treatment modalities such as 15 independent are predictors factors of survival time in patients with bladder cancer prognosis. Also found that the age of morbidity in the multivariate analysis, hemoglobin, neutrophil (seg), creatinine and postoperative cancer of the other as the most important survival time prognostic factors. Based on the results of this study, the following specific recommendations are made: 1.To strengthen the attention to early screening for bladder cancer, with early detection and early treatment, thereby the reducing the risk of death and improving survival are possible. 2. The routine use of biochemical test items, including hemoglobin, neutrophil (Seg), creatinine testing, may assist in the evaluation of bladder cancer, and be an important reference for clinical decision making. 3. The prognosis of surgical resection and chemotherapy for bladder cancer patients is better than that of only surgical resection. Clinicians should evaluate the predictors of survival prognosis and provide personalized medicine to improve the medical quality of cancer treatment. |
