| Abstract: | 肺癌一直是世界上癌症主要死因之一。最近的證據顯示慢性發炎與癌症的發生有關。在慢性發炎的肺病中，氣喘(asthma)、慢性阻塞性肺病(COPD)與結核病(TB)被發現與肺癌有關。肺癌的存活率主要與病人身體狀態、性別、肺癌的組織病理型態、期別與共病有密切相關。隨著人口老化，超過一半以上的肺癌病人有3種以上的共病。然而對於先前存在的多種肺病是否會增加罹患各種細胞型態的肺癌與死亡率，目前仍然是未明的。 首先從健保資料庫找出新診斷的肺癌個案。接著串連癌登檔找出肺癌的病理型態。利用Cox比例風險模式計算出肺病與罹患各種細胞型態的肺癌風險。同時也利用Cox比例風險模式計算出肺病與肺腺癌死亡風險。 結果顯示存在多種肺病顯示與肺癌有更密切相關。明確的來說，在男性，有asthma+COPD+TB、asthma+COPD與COPD+TB的病患罹患鱗狀上皮癌的風險分別是3.98 (95% CI, 3.22-4.93)、2.68 (95% CI, 2.45-2.93)與2.57 (95% CI, 2.10-3.13); 就女性而言，有TB、COPD+TB和asthma+COPD的病患罹患鱗狀上皮癌的風險分別是3.64 (95% CI, 1.88-7.05)、3.35 (95% CI, 1.59-7.07)與2.21 (95% CI, 1.66-2.94)。就肺腺癌而言，有asthma+COPD+TB、COPD+TB與asthma+TB的病患罹癌的風險，男女分別是2.00 (95% CI, 1.54-2.60)與2.82 (95% CI, 1.97-4.04) 、 2.28 (95% CI, 1.91-2.73)與2.16 (95% CI, 1.57-2.95) 和1.76 (95% CI, 1.04-2.97)與2.04 (95% CI, 1.02-4.09)。就小細胞癌而言，有asthma+TB、asthma+COPD+TB與asthma+ COPD的男性病患罹癌的風險分別是3.65 (95% CI, 1.97-6.80)、2.20 (95% CI, 1.45-3.36) 與2.14 (95% CI, 1.86-2.47); 而有asthma+COPD+TB、COPD+TB與 asthma+COPD的女性病患罹癌的風險分別是8.97 (95% CI, 3.31-24.28)、3.94 (95% CI, 1.25-12.35)與3.33 (95% CI, 2.23-4.97)。 就肺腺癌的死亡而言，有asthma、COPD與TB的病患死亡的風險，男女分別是1.20 (95% CI, 1.10-1.30)與1.05 (95% CI, 0.95-1.16)、1.32 (95% CI, 1.16-1.51)與0.97 (95% CI, 0.89-1.05) 和0.99 (95% CI, 0.93-1.06)與1.06 (95% CI, 0.86-1.32)。明確的來說，有asthma+COPD+TB、asthma+COPD與COPD+TB的男性病患死亡的風險分別是1.63 (95% CI, 1.25-2.13)、1.31 (95% CI, 1.08-1.59)與1.23 (95% CI, 1.11-1.36)。然而，存在多種肺病並不會增加女性病人的死亡率。 利用癌登資料分析發現肺腺癌與大腸直腸癌有密切關係; 推測基因可能扮演主要的角色。此外，從肺病與肺癌風險和死亡分析中發現糖尿病與高血脂症與罹患肺癌的風險和肺腺癌的死亡有關。由於目前沒有預測糖尿病的最好指標而且健保資料庫無實驗數據，我們利用2002年三高資料庫作橫斷性研究。我們發現 ApoA1/HDL-C優於其他指標而且同時在男女性對糖尿病有線性相關。素食被發現可以降低高血脂症因此我們利用2002年三高資料庫作素食與血脂質的研究。研究中發現蛋奶素可以有效降低低密度膽固醇，比全素食更適合男性。
Lung cancer remains the leading cause of cancer death worldwide. Recent evidence suggested that chronic inflammation has been associated with lung carcinogenesis. Among lung comorbidities with chronic inflammation, asthma, chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB) have been associated with lung cancers. Lung cancer survival mainly depends on patients’ characteristics, gender, histologic cell types, stage and comorbidities. With the increasing mean age, more than half of patients with lung cancer had 3 or more comorbidities. However, whether patients with coexisting pulmonary diseases are at greater risk of developing various histologic types of lung cancer and mortality remains elusive. Patients newly diagnosed with lung cancer were identified from National Health Insurance Research Database (NHIRD). The histologic types of lung cancer were further confirmed using Taiwan Cancer Registry Database (TCRD). Cox proportional hazard regression was used to calculate the hazard ratio (HR) of coexisting asthma, COPD and/or TB to estimate lung cancer risk by histologic type. For mortality risk, the HR of coexisting asthma, COPD and/or TB were calculated to estimate all-cause mortality risk of lung adenocarcinoma. Coexisting pulmonary diseases showed stronger association with lung cancer than specific lung disorders. Specifically, among men, the HRs for squamous cell carcinoma were 3.98 (95% CI, 3.22-4.93), 2.68 (95% CI, 2.45-2.93) and 2.57 (95% CI, 2.10-3.13) for individuals with asthma+COPD+TB, asthma+COPD, and COPD+TB respectively. Among women, the HRs for squamous cell carcinoma were 3.64 (95% CI, 1.88-7.05), 3.35 (95% CI, 1.59-7.07), and 2.21 (95% CI, 1.66-2.94) for individuals with TB, COPD+TB, and asthma+COPD respectively. Adenocarcinoma HRs for men and women were 2.00 (95% CI, 1.54-2.60) and 2.82 (95% CI, 1.97-4.04) for individuals with asthma+COPD+TB, 2.28 (95% CI, 1.91-2.73) and 2.16 (95% CI, 1.57-2.95) for COPD+TB, and 1.76 (95% CI, 1.04-2.97) and 2.04 (95% CI, 1.02-4.09) for individuals with asthma+TB. Specifically, small cell carcinoma HRs among men were 3.65 (95% CI, 1.97-6.80), 2.20 (95% CI, 1.45-3.36) and 2.14 (95% CI, 1.86-2.47) for those with asthma+TB, asthma+COPD+TB, and asthma+ COPD. Among women, the HRs of small cell carcinoma were 8.97 (95% CI, 3.31-24.28), 3.94 (95% CI, 1.25-12.35) and 3.33 (95% CI, 2.23-4.97) for those with asthma+COPD+TB, COPD+TB, and asthma+COPD respectively. For mortality, the HRs of adenocarcinoma in men and women were 1.20 (95% CI, 1.10-1.30) and 1.05 (95% CI, 0.95-1.16) for individuals with asthma, 1.32 (95% CI, 1.16-1.51) and 0.97 (95% CI, 0.89-1.05) for COPD, and 0.99 (95% CI, 0.93-1.06) and 1.06 (95% CI, 0.86-1.32) for individuals with TB. Specifically, among men with coexisting pulmonary diseases, the HRs were 1.63 (95% CI, 1.25-2.13), 1.31 (95% CI, 1.08-1.59) and 1.23 (95% CI, 1.11-1.36) for individuals with asthma+COPD+TB, asthma+COPD, and COPD+TB, respectively. However, there was no increase risk of mortality among women with coexisting pulmonary diseases. We also analyzed data from TCRD and found that the incidence of lung adenocarcinoma was associated with colon cancer. The association suggests that some factor, like genes, may be important as determinants for the association between lung adenocarcinoma and colorectal cancer. Besides, DM and hyperlipidemia were associated with development and mortality of lung cancer from our results. The laboratory data were not available in the NHIRD. We tried to find the association between lipid profiles and DM using the 2002 Taiwanese Survey on the Prevalence of Hyperglycemia, Hyperlipidemia and Hypertension (TwSHHH). We found that ApoA1/HDL-C had a significant linear association with diabetes in both sexes and was superior to other lipid and lipoprotein variables among the general Taiwanese population. Vegetarians tend to have low hyperlipidemia than omnivorous subjects. We also evaluated the association between vegetarian diet and lipid profiles using TwSHHH. Ovo-lacto vegetarian diet was effective in lowering LDL-C, it may be more appropriate for males. |
