不同透析方式對病患罹患泌尿道癌之相對風險分析

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Title:	不同透析方式對病患罹患泌尿道癌之相對風險分析 Risk of Urinary Tract Cancer on Different Dialysis Modality Patients in Taiwan
Authors:	郭佳隴;Jia-Lung Kuo
Contributors:	公共衛生學院醫務管理學研究所碩士班
Keywords:	血液透析;腹膜透析;Peritoneal dialysis;Hemodialysis;Transitional cell carcinoma;Renal cell carcinoma
Date:	2010
Issue Date:	2010-09-29 12:05:50 (UTC+8)
Abstract:	目地: 本研究探討台灣末期腎病病患罹患泌尿道癌之情形並分析不同透析方式對末期腎病病患罹患泌尿道癌之相對風險。方法: ：利用1997年至2007 年的全民健康保險研究資料庫，以回溯性世代研究法，將這11年間所有新接受透析治療超過三個月之末期腎病病患納入分析。研究對象計有78,568位新接受透析治療之末期腎病病患 (其中有73,961位病患接受血液透析，4,607位接受腹膜透析)。除描述性統計及雙變項分析外，使用Cox proportional hazard regression models分析造成透析病患罹患泌尿道癌之相關因子。結果: 計有1,824位透析病患罹患泌尿道癌(2.49%)。Cox proportional hazard models結果顯示，在控制其他變項後，接受血液透析病患較接受腹膜透析者有較高罹癌機率(罹癌相對風險:1.968，95%信賴區間: 1.472-2.632)。其他顯著相關因素還包括；年齡層大於40歲有較高罹癌機率(年齡層41-50歲, 51-60歲, 61-70歲, > 70歲其罹癌相對風險性分別為: 4.5， 6.653， 6.28及 5.952)、女性病患(罹癌相對風險:1.235，95%信賴區間: 1.119-1.363)、後天性腎囊腫(罹癌相對風險:1.612，95%信賴區間: 1.336-1.944)、高血壓(罹癌相對風險:0.475，95%信賴區間: 0.431-0.524)、糖尿病(罹癌相對風險:0.304，95%信賴區間: 0.269-0.342)及不同的透析機構層級(於醫學中心接受透析治療病患較於其他層級機構接受透析治療病患有較高罹癌機率)。結論: 接受腹膜透析之末期腎病患者較接受血液透析之患者有顯著較低罹患泌尿道癌的機率。雖然腎臟專科醫師的偏好以及保險支付制度皆會影響病患對透析方式的選擇，本研究卻有不同的建議，腹膜透析的確值得更大力的推廣。 Objective: This study investigated the relationship between end-stage renal disease (ESRD) patients and urinary tract cancer and also examined the impact of dialysis modality on the incidence of the urinary tract cancer. Methods: The retrospective cohort study was based on 11-year nationwide dialysis patients obtained from the National Health Insurance Research dataset. The study subjects included 78,568 new dialysis patients and of which 73,961 new hemodialysis (HD) patients and 4,607 new peritoneal dialysis (PD) patients were included. Besides bivariate analysis, this study used Cox proportional hazards regression models to examine the related factors influencing the dialysis patients to suffer from the urinary tract cancer. Results: The incident rates of the urinary tract cancer are 2.49% (1,824) for dialysis patients. The Cox regression models indicated that the following variables were significant factors associated with urinary tract cancer: peritoneal dialysis (Relative risk (RR): 0.468, 95% CI: 0.352-0.621), age group 41-50 years, 51-60 years, 61-70 years, > 70 years (RR: 4.5, 6.653, 6.28, 5.952 respectively), male gender (RR: 0.784, 95% CI: 0.712-0.862), acquired cystic kidney disease (ACKD) (RR: 1.501, 95% CI: 1.245-1.808), hypertension (RR: 0.498, 95% CI: 0.452-0.548), diabetes mellitus (DM) (RR: 0.33, 95% CI: 0.294-0.371) and level of dialysis facilities. Conclusion: Peritoneal dialysis patients have a urinary tract cancer-specific advantage as compared to hemodialysis patients in Taiwan. Although the nephrologist’s preference and the reimbursement system would influence the under-utilization of peritoneal dialysis, peritoneal dialysis deserved more promotion as treatment options to ESRD patients.
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