| 摘要: | 背景：根據世界衛生組織估計至2008年，約有123萬人罹患大腸直腸癌，且超過60萬人因此癌症而死亡。研究顯示在手術前常有期別判定困難之事，導致術後因與病理期別之差異而引起病人對醫師產生不信任感。 目的：本研究目的為探討大腸直腸癌腫瘤大小對腸壁侵襲深度的影響，分析其與病理期別及對病患5年存活率等之相關影響。 方法：採次級資料分析。以嘉義市某區域教學醫院於2004 至2008年期間，癌症登記資料庫內所登錄之大腸直腸癌患者之病歷資料，利用描述性統計及卡方分佈分析大腸直腸癌腫瘤大小對癌症各期別及存活率之影響。 結果：符合本研究之分析人數共695人。結果顯示，腫瘤大小與性別、及年齡中位數無相關，但與腸壁之侵襲深度有相關性 (P<0.001)。將腫瘤區分為右側大腸、左側大腸及直腸三個部分後，以上述不同區域之腫瘤中位數（60.0 mm、42.5 mm及45.0 mm）為分析基礎，發現左側大腸的腫瘤大小中位數亦對病理期別皆具相關性 (P=0.005)。且直腸癌腫瘤大小中位數則與區域淋巴結轉移、遠端轉移及病理期別皆具相關性 (P=0.005、0.01及<0.001）。未加入調整因子前，左側大腸及直腸之腫瘤大小中位數與五年存活率皆具相關性(P=0.036及0.012)。 結論：本研究結果顯示，腫瘤越大之大腸直腸癌其腸壁侵襲度越深。尤其當直腸癌大於45 mm時，應防範區域淋巴結及遠端器官轉移之可能性。
Background: It is estimated by the World Health Organization that worldwide, in 2008, 1.23 million cases of colorectal cancer were clinically diagnosed, and that it killed over 600 thousand people. Though preoperative staging of colorectal cancer is important, making the final decision has shown very complicated. This might be resulted in an inapropriated expectation of patients to the course of the disease. Furthermore, the discrepancy of preoperative and postoperative stagings also may make complaints from doctors and patients. Purpose: The goal of this study was to investigate the relationships between tumor size in colorectal cancer and depth of bowel wall invasion, and the associations between the stage of cancer and 5-year survival rate refers to the percentage of patients. Methods: Researchers used secondary data analysis to assess the associated factors of tumor size, stage of cancer, and 5-year survival rate of coloreatal cancer individuals provided from the Cancer Registory database established by a regional teaching hospital in Chiayi city from 2004 to 2008. Descriptive statitstics and chi-square test were used to evaluate the independent factors of tumor size in colorectal cancer associated with and the depth of bowel wall invasion and 5-year survival rate. Results: A total of 695 cases were enrolled in this study. Results showed that the tumor size was not correlated with gender and age, while it was significantly associated with the depth of bowel wall invasion (P<0.001). In turn of tumor in right colon, left colon and rectum were further subtyped by their median sizes (60 mm, 42.5 mm, and 45 mm, respectively) to analyze the associated factors among median tumor size, bowel wall invasion, and stage of tumor. Results showed that the median tumor size in left colon still significanty associated with the pathological stage. The rectum also significanty associated with the pericolic lymph node, the distances of metastasis, and stage of tumor (P=0.005, 0.001, and <0.001, respectively).The median tumor sizes of left colon and rectum were significanty associated with the 5-year survival rate (P=0.036 and 0.012, respectively. Conclusions: In conclusion, the tumor size was significantly associated with the depth of bowel wall invasion. The health care professionals should pay more attention to pericolic lymph node and the distant metastasis, especially the rectal cancer size is over 45mm. |
