| Abstract: | 背景：肺腺癌上升趨勢已成為國際上的重要議題，但有關肺腺癌發生率的年代效應研究通常只進行年齡調整，很少同時調整年齡及出生世代。
研究目的：利用年齡、年代及世代效應模式(Age-Period-Cohort model, APC model)進行19個國家肺癌發生率及其組織病理型態的年代效應分析。
材料方法：資料來源為世界衛生組織1978-1997年18個國家及台灣行政院衛生署。肺癌及其組織病理型態的年齡標準化發生率是將1978-1997年以每五年為一組、30至79歲以每五歲為一層計算。進一步利用APC model計算年齡、年代及出生世代效應。
結果：19個國家肺腺癌（adenocarcinoma, AC）年齡標準化發生率性別比值相對於肺鱗狀細胞癌（squamous cell cancer, SCC）年齡標準化發生率性別比值是較低的。進一步將年齡標準化發生率性別比值依地理屬性分為北美洲、亞洲和歐洲進行比較，結果發現歐洲地區之肺腺癌年齡標準化發生率性別比值為3.39 ± 1.51、肺鱗狀細胞癌年齡標準化發生率性別比值為14.20 ± 10.43，皆高於北美洲（肺腺癌：1.54 ± 0.02、肺鱗狀細胞癌：3.85 ± 0.49）和亞洲（肺腺癌：1.93 ± 0.38、肺鱗狀細胞癌：6.83 ± 1.81）。經調整過年齡與出生世代後，19個國家肺腺癌及肺鱗狀細胞癌發生率的年代效應有不同變化情形。肺腺癌發生率的年代效應中，台灣、法國、日本及斯洛伐克在男、女性皆有上升趨勢；新加坡及印度男、女性皆緩慢上升；美國、加拿大及義大利男性緩慢下降而女性緩慢上升；西班牙及澳洲男、女性皆下降；荷蘭、波蘭和瑞士男性急速下降、女性上升；英國及丹麥男性緩慢上升、女性上升；愛沙尼亞和冰島男性急速下降、女性急速上升；男、女性皆維持不變的只有以色列。肺鱗狀細胞癌發生率的年代效應中，台灣及愛沙尼亞在男、女性皆有上升趨勢；新加坡、印度、澳洲、日本、丹麥、美國、荷蘭、英國、瑞士、義大利、法國及以色列男、女性皆下降；西班牙反男性緩慢上升、女性急速上升；冰島男性上升、女性急速下降；斯洛伐克及波蘭男性維持穩定、女性緩慢上升。
結論：肺腺癌及肺鱗狀細胞癌發生率男性皆高於女性。肺鱗狀細胞癌發生率之性別比值相較於肺腺癌發生率之性別比值大。肺腺癌發生率之年代效應中，男性則在19個國家中半數的年代效應是上升，這些上升的國家大都集中在亞洲國家男性；大部分國家的女性都是上升。此外，台灣男女性發生率的年代效應也是上升的情況。至於肺鱗狀細胞癌發生率之年代效應，在新加坡及大部分歐美國家男女性年代效應都是下降的趨勢，而台灣男女性發生率的年代效應卻都是上升的趨勢。
Objective: We analyzed the incidence data of lung cancer from 1978 to 1997 among men and women between 19 countries.
Methods: The data were collected from 18 countries in World Health Organization and Department of Health in Taiwan during in the period of 1978 to 1997. Age-standardized incidence rates（ASIR） were analyzed in five consecutive five-year periods and for each five-year age group in the age range 30 to 79. An age-period-cohort（APC） model were used to estimate the effects of age, generation and cohort of birth.
Results: The sex ratio of the ASIR for adenocarcinoma（AC） was lower than sex ratio of the ASIR for squamous cell carcinoma（SCC） in 19 countries. The sex ratio of the ASIR for adenocarcinoma and squamous cell carcinoma in Europe（AC 3.39±1.51, SCC 14.20±10.43）is higher than in Asia（AC 1.93±0.38, SCC 6.83±1.81） or in North America（AC 1.54±0.02, SCC 3.85±0.49）. The period effects（AC） for males and females from the APC model applied to the data from the 19 countries: an increasing trend in both sexes, seen in Taiwan, France, Japan and Slovakia; a gradual increasing trend in both sexes, seen in Singapore and India; a sharply increasing trend in women, and a sharply decreasing trend in men, seen in Estonia and Iceland; a more gradual increasing trend in women, but a gradual declining trend in men, seen in USA, Canada and Italy; a decreasing trend in both sexes, seen in Spain and Australia; a gradually increasing trend in men, but a increasing trend in women, seen in England and Wales and Denmark; a relatively steady trend in both sexes, seen only in Israel; a sharply decreasing trend in men, but a sharply increasing trend in women, seen in Netherlands, Poland and Switzerland.
The period effects（SCC） for males and females from the APC model applied to the data from the 19 countries: an increasing trend in both sexes, seen in Taiwan and Estonia; an decreasing trend in both sexes, seen in Singapore, USA, England and Wales, Netherland, Switzerland, Japan, India, Israel, France, Denmark, Italy and Australia; a sharply increasing trend in both sex, seen only in Spain; a sharply decreasing trend in women, but a increasing trend in men, seen only in Iceland; a relatively steady trend in men, but a gradually increasing trend in women seen in Slovakia and Poland.
Conclusions: The sex ratio of the ASIR for adenocarcinoma（AC） was lower than sex ratio of the ASIR for squamous cell crcinoma（SCC） in 19 countries. These trends may reflect that SCC related with sex difference more than AC. A period effect（AC） was increasing in both sex seen in most countries, especially in Taiwan and Asia countries. But a period effect（SCC） decreasing in both sex seen in most countries（Singapore, North America and Europe countries）. A period effect（SCC） was increasing in both sex seen in Taiwan. |
