| Abstract: | 肺癌仍是最主要癌症死因，許多研究致力於探索肺癌危險因子、開發更準確診斷工具並發展更具效果治療方法與策略，歷年來肺癌的發生率及肺癌患者的特徵應該也會有所變遷。肺癌病患的性別、年齡、組織類型、期別與治療使用情形需要再次評估，以瞭解過去肺癌防治策略的成效並規劃未來相關的工作項目。
本研究是一項描述性流行病學研究，主要目的包含(1) 瞭解2007-2017年肺癌新診斷病患的趨勢分析，並依照性別及組織類型分層探討。(2) 比較2007-2012與2013-2017兩時期肺癌新診斷病患的特性與治療方式之變遷。
利用2007-2017年中部某醫學中心之癌症登記資料進行分析，共2,328筆病歷號資料被初次診斷為肺癌(ICD-O-3 C34.x)。本研究所使用的變項如(1)基本人口學特徵；(2)癌症診斷相關變項；(3) 癌症治療相關變項。年代趨勢以折線圖(line chart)或直方圖(histogram)觀察人數或百分比是否有逐年上升、下降或特定的變化情形。以分段回歸分析(Segmented regression analysis)評估新診斷肺癌人數的年代變化並使用R分析軟體中changepoint的套件探索改變點。邏輯斯迴歸模型 (Logistic regression model)用於比較2007-2012及2013-2017新診斷肺癌患的特徵或治療差異。
肺癌新診斷人數趨勢，自2012年後肺癌新診斷人數平均每年增加30.54(95% C.I.: 20.98, 40.10)人。男性2011年後每年平均增加11.20(95% C.I.: 4.54, 17.86) 人達到統計顯著。女性2007-2013年每年平均增加2.71(95% C.I.: 0.36, 5.07) 人、2014-2017年每年平均增加26.60(95% C.I.: 21.03, 32.17) 人皆達到統計顯著。肺腺癌新診斷人數2007-2017呈現逐年增加的趨勢，2014年起每年平均增加男性13.05人、女性23.90人。男性肺鱗狀細胞癌新診斷人數自2007至2017年呈現逐年降低的趨勢，估計每年減少4.28%
肺癌新診斷患者有逐年年輕化狀態(年齡中位數由2007-2012年的67歲減少至2013-2017年的63歲。)，且診斷期別為早期癌的比例也逐漸提升。數據顯示新診斷肺癌的臨床特徵品質有所提升，數據為遺漏或不明的比例都有明顯的下降。
臨床期別: 0, I, II 的手術比例自2007-2012年的71.43%提升到2013-2017年的92.56%，然而放射治療、化學治療的比例微幅下降。臨床期別: III, IV的化學治療比例自2007-2012年的68.90%降低到2013-2017年的44.93%，取而代之的是標靶治療自10.58%提升至42.95%。
肺癌新診斷人數正逐年增加，本院相關外科、病房等設備硬體設備以及相關諮詢服務應評估是否可滿足逐年增加的需求。肺腺癌相關危險因子的研究仍是近年重要的議題，本院逐年增加的肺腺癌人數除了反應疾病的狀態外，應著力進行防治的相關計畫。隨著診斷患者的年輕化以及早期診斷，應該致力於探討患者診斷/治療後的預後及死亡率是否亦有所改善。隨著癌症治療指引的更新與新穎的手術/藥物技術發展，肺癌患者治療的方式亦產生變化，然而治療改變是否有效的提升病患的生活品質或存活率仍需要被評估。
Lung cancer continues to be the leading cause of deaths associated with cancer. Therefore, many studies are devoted to exploring lung cancer risk factors and developing more accurate diagnostic tools more effective treatments and strategies. The incidence of lung cancer and the characteristics of lung cancer patients have also changed over the years. The gender, age, tissue type, stage, and use of treatment of lung cancer patients need to be reassessed to understand the effectiveness of past lung cancer prevention strategies and to plan for related work in the future.
This study is a descriptive epidemiological study with the following objectives: (1) to understand and analyze the trend of newly diagnosed lung cancer patients in 2007-2017 and stratifying them according to gender and tissue type, and (2) to compare the characteristics and treatment methods of newly diagnosed lung cancer patients between 2007-2012 and 2013-2017.
This study used data from the cancer registry of a Medical center at Taichung from 2007 to 2017 for analysis. A total of 2,328 medical record data were initially diagnosed as lung cancer (ICD-O-3 C34.x). The variables used in this study were (1) basic demographic characteristics; (2) cancer diagnosis-related variables; and (3) cancer treatment-related variables. The yearly trend, whether the number or percentage of lung cancer incidence rises, falls, or changes in a specific way, is illustrated using a line chart or a histogram. Segmented regression analysis was used to assess the chronological changes in the number of newly diagnosed lung cancers and to explore changes using the change points in R analysis software. Logistic regression model was used to compare the characteristics or treatment differences of newly diagnosed lung cancer patients from 2007 to 2012 and 2013-2017.
The number of new diagnoses of lung cancer since 2012 has increased by an average of 30.54 (95% C.I.: 20.98, 40.10) per year. After 2011, the average annual increase of lung cancer incidence for males is 11.20 (95% C.I.: 4.54, 17.86) persons, which reaches statistically significance. For females, the average annual increase lung cancer incidence in 2007-2013 and 2014-2017 was 2.71 (95% C.I.: 0.36, 5.07) persons and 26.60 (95% C.I.: 21.03, 32.17) persons, respectively. Both of which are statistically significant. The number of new diagnoses of lung adenocarcinoma has increased year by year in 2007-2017. Since 2014, the average annual increase for males is 13.05 persons and for females is 23.90 persons. However, the number of new diagnoses of lung squamous cell carcinoma in males has been decreasing year by year from 2007 to 2017, with an estimated annual decrease of 4.28%.
Patients who are newly diagnosed with lung cancer are becoming younger (the median age was reduced from 67 years in 2007-2012 to 63 years in 2013-2017), and the proportion of cancers diagnosed early is also gradually increasing. Data shows that the clinical features of newly diagnosed lung cancer have improved, and the proportion of data that is missing or unknown has decreased significantly.
For patients who are clinically staged at 0, I, II, surgery has increased from 71.43% in 2007-2012 to 92.56% in 2013-2017, but the proportion of radiation therapy and chemotherapy has slightly decreased. For those who were clinically staged at III and IV, the proportion of chemotherapy decreased from 68.90% in 2007-2012 to 44.93% in 2013-2017, but targeted treatment has increased from 10.58% to 42.95%.
The number of new diagnoses of lung cancer is increasing year by year. Related surgery departments, hospital beds, equipment, hardware and other related consulting services should be evaluated in order to meet the increasing demand. The research on risk factors related to lung adenocarcinoma is still an important issue in recent years. The increasing trend of lung cancer in the hospital reflects not only the state of the disease, but also the need to focus on prevention and treatment. With earlier diagnosis and the incidence of lung cancer patients being younger, efforts should be made to investigate whether the prognosis and mortality after diagnosis/treatment are improved. With the update of cancer treatment guidelines and the development of novel surgical/drug technology, the treatment of lung cancer patients has also changed accordingly. However, whether the treatment changes are effective in improving the quality of life or survival rate of patients still needs to be evaluated. |
