| 摘要: | 目的：雖然胃癌的死亡率在世界各地，包括台灣，均呈下降的趨勢，但是目前仍是世界第二位最常見的癌症死因；依據2004年衛生署之癌症死亡統計，胃癌為國人十大癌症死因的第五位，分居女性癌症死因的第六位，男性癌症死因的第五位。胃癌對國人健康的影響仍不容小覷。本研究包括分析國人胃癌盛行、發生和存活的趨勢，及一個病例對照研究探討胃癌發生的相關危險因子。
方法：使用國民健康保險二十萬人的世代抽樣檔門診與住院資料，利用ICD9和A-code檢出病例，計算1997至2003年胃癌的發生率，以百分比表示。使用1981-2002年的全國癌症登記檔案，以卡方檢定分析不同性別、診斷年齡、通報醫院、戶籍地、癌症部位、組織病理、診斷依據、治療情形、死亡原因等變項的分布。
以醫院為基礎的病例對照研究（hospital-based case-control study）資料則在高雄地區執行，以問卷為研究工具，收集人口、生活形態和飲食等環境因子，探討與胃癌之相關性。以卡方檢定比較各種危險因子的分布，再以conditional logistic regression分析各危險因子對胃癌的危險性。
結果：從健保檔分析結果顯示，男性胃癌發生率較女性高（25.4/105對19.6/105，p<0.0001）。以40歲以下基準，罹患胃癌的危險性有隨年齡增加的趨勢。在多變項邏輯斯迴歸分析中，男性發生胃癌危險是女性的1.27倍（95% CI=1.03-1.55）。與年輕的民眾相較，胃癌發生危險隨年齡增加而增加，勝算比由40-49歲的6.1（95% CI=3.92-9.44），增加到80歲以上的47.8（95% CI=30.6-74.6）。
從癌症登記檔分析結果顯示，女性的5年存活率比男性的高（25.2%對23.8%, p=0.08）、醫院層級（p=0.003）、是否為教學醫院（p=0.030）、地區別（p<0.0001）、所在地人口密度（p=0.0001）及治療方法數（p=0.034）等分布，具有統計上顯著意義。從病例對照研究分析結果顯示蔬菜及維他命的攝取具保護作用，每週攝取蔬菜水果次數35次以上者罹患胃癌勝算比（odds ratio）為0.44。
結論：國民健康保險資料分析顯示男性胃癌發生率較女性為高，且年紀越大罹患胃癌的相對危險性也越高。蔬菜水果及維他命的使用將有助於降低罹患胃癌的風險。
Gastric cancer is one of the leading causes of cancer deaths worldwide, the fifth in Taiwan, and the second in Japan and United States. This thesis study used three data sets to evaluate the trend of incidence, survival rate and risk factor for the disease.
Methods: First, this study reported the incidence of gastric cancer in Taiwan from 1997 to 2003, based on a cohort sample of 200,000 persons established from claim files of National Health Insurance. Cases of gastric cancer were identified according to International Classification of Disease 9 edition and A-code for both inpatients and out patients.
Second, the study reported the survival trends of gastric cancer in Taiwan from 1981 to 2002, based the data obtained from the National Cancer Registry. Finally, analysis was using data obtained for a hospital-based case-control study conducted in Kaohsiung area. Each study subject completed a questionnaire on socio-demographic, lifestyle and dietary factors, and other potential covariates. The study population consisted of 111 gastric cancer cases and 222 controls with no gastric cancer. Odds ratios (OR) and 95% confidence intervals (CI) for gastric cancer were calculated for the association with the above mentioned variables using the Conditional logistic regression analysis.
Results: Based on the data of National Health Insurance from 1997 to 2003, the incidence of gastric cancer in the cohort decreased from 35.9/105 to 18.3/105 in men and from 25.14/105 to 12.19/105 in women. The multivariate logistic regression showed that men were 1.27 times (95% CI = 1.03-1.55) then women to have the disease. Odds ratio of the disease increased as age increased, from 6.1 (95% CI = 3.92-9.44) for the population of 40-49 years old to 47.8 (95% CI = 30.6-74.6) for those of 80 years old and above, compared with those aged younger than 40 years.
Results based on analyzing the data of National Cancer Registry showed that the 5 year survival rate was higher in females than in males (25.2% vs. 23.8%, p=0.08). The survival rate for patients cared at medical center hospitals was higher than other hospitals (p<0.0001). Results of the case-control study showed that the risk of stomach cancer was inversely related to the intake of total fruits and dark green-yellow vegetables and vitamins. The odds ratio reduced to 0.44 for those with the weekly in take of vegetable/ fruit for 35 times or more.
In conclusion, this study indicates that the incidence of stomach cancer is higher in men than in women. The survival rate of females was higher than that of males. Intake of fruits, vegetables and vitamins were protective for gastric cancer. |
