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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 陳秀熙(Hsiu-Hsi Chen) | |
dc.contributor.author | Hung-Pin Chen | en |
dc.contributor.author | 陳宏賓 | zh_TW |
dc.date.accessioned | 2021-05-20T20:58:14Z | - |
dc.date.available | 2011-10-03 | |
dc.date.available | 2021-05-20T20:58:14Z | - |
dc.date.copyright | 2011-10-03 | |
dc.date.issued | 2011 | |
dc.date.submitted | 2011-07-27 | |
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Does Screening or Surveillance for Primary Hepatocellular Carcinoma with Ultrasonography Improve the Prognosis of Patients? The Cancer Journal 2004;10(5):317-25. 37. Chen TH-H, Chiu Y-H, Luh D-L, Yen M-F, Wu H-M, Chen L-S, et al. Community-based multiple screening model. Cancer 2004;100(8):1734-43. 38. Zhang B-H, Yang B-H, Tang Z-Y. Randomized controlled trial of screening for hepatocellular carcinoma. Journal of Cancer Research and Clinical Oncology 2004;130(7):417-22. 39. Rothman KJ, Greenland S, Lash TL. Modern epidemiology: Lippincott Williams & Wilkins, 2008. 40. Chen H, Duffy S, Tabar L. A Markov chain method to estimate the tumour progression rate from preclinical to clinical phase, sensitivity and positive predictive value for mammography in breast cancer screening. Journal of the Royal Statistical Society. Series D (The Statistician) 1996;45(3):307-17. 41. Chen TH-H, Yen M-F, Lai M-S, Koong S-L, Wang C-Y, Wong J-M, et al. Evaluation of a selective screening for colorectal carcinoma. Cancer 1999;86(7):1116-28. 42. Chen THH, Kuo H, Yen M, Lai M, Tabar L, Duffy S. Estimation of sojourn time in chronic disease screening without data on interval cases. Biometrics 2000;56(1):167-72. 43. Etzioni RD, Connor RJ, Prorok PC, Self SG. Design and analysis of cancer screening trials. Statistical Methods in Medical Research 1995;4(1):3. 44. Chen L-S, Yen AM-F, Duffy SW, Tabar L, Lin W-C, Chen H-H. Computer-aided System of Evaluation for Population-based All-in-One Service Screening (CASE-PASS): From Study Design to Outcome Analysis with Bias Adjustment. Annals of Epidemiology 2010;20(10):786-96. 45. Yuen M-F, Hou J-L, Chutaputti A. Hepatocellular carcinoma in the Asia pacific region. Journal of Gastroenterology and Hepatology 2009;24(3):346-53. 46. Chen C-H, Su W-W, Yang S-S, Chang T-T, Cheng K-S, Lin HH, et al. 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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/10048 | - |
dc.description.abstract | 背景:肝癌是目前台灣地區惡性腫瘤死亡的第一位,就發生率而言亦為好發腫瘤之一,肝癌的篩檢為目前防治肝癌的必要手段。本論文主要目的在早期評估以危險分數為導向的肝癌社區到點超音波篩檢計畫之效益。
材料和方法:本研究的對象取自2005至2010年間參加彰化縣社區整合式篩檢且年齡介於45-69歲間共計41412人。利用已發展的危險分數公式將參加者區別為極高危險群、高危險群、中危險群和低危險群。個案中符合HBsAg(+)、Anti-HCV(+)、異常AFP中的其中一項,利用危險分數計算公式,並以危險分數的中位數區隔為極高危險群及高危險群。其他三項指標皆陰性者,亦利用危險分數計算公式得到其危險分數,再以前1/4及後3/4區分為中危險群和低危險群。並由衛生局主導,依危險分數作為優先性,並邀請個案至衛生所接受肝癌超音波檢查。利用比例風險回歸模型評估超音波篩檢偵測、兩階段篩檢偵測及臨床症狀偵測三類個案之風險,並調整前導期偏差。利用盛行池概念計算不同危險分層個案之平均滯留期,並推估不同危險分層在不同篩檢間隔之下的篩檢效益。 結果:本計畫經由超音波篩檢偵測之確診肝癌共19位。在極高危險群有16位肝癌,偵測率為千分之5.3 (=16/3013);在高危險群為千分之0.7 (=2/2732);在中間危險群為千分之0.4 (=1/2819),而在低危險群中接受超音波檢查之426人並沒有發現肝癌個案。19位肝癌中,腫瘤大小小於3公分為8位,佔42.11%;3-5公分為9位,佔47.37%;大於5公分為2位,佔10.53%。超音波偵測、兩階段篩檢偵測及臨床偵測個案的之危險比,分別為0.15 (95% CI: 0.04-0.59)及0.41 (95% CI: 0.21-0.78),前導期偏差調整後危險比分別提高為0.31 (95% CI:0.12-0.84)及0.63 (95% CI: 0.37-1.08)。極高危險群、高危險群、中危險群之平均滯留期為 1.10年、1.27年、3.55年。 就極高危險群而言,每季篩檢一次約可減少61%肝癌死亡,每半年一次篩檢其篩檢效益約為54%,若為每年,則可減少約51%,此效益隨著篩檢間隔變長而變小,若為每六年一次篩檢,則僅約減少14%肝癌死亡。在其他危險分層亦可見相似情況。若以高危險群每半年篩檢一次,即目前台灣地區全民健康保險的策略為基準,欲避免一個肝癌死亡需進行37,547次腹部超音波篩檢,此效益類推至中危險群可建議此類族群的篩檢間隔約介於4-6年,但對低危險群而言,就算六年一次篩檢,所需使用的超音波檢查資源亦高於高危險群每半年篩檢一次的結果。 結論:以社區為基礎、危險分數為導向的腹部超音波篩檢計畫可以找到較多小型肝癌,並得到較佳的存活狀況。依據危險分數決定優先性的邀約及以衛生所為定點提供的到點篩檢服務可增加民眾參與率,並提高篩檢產出。本計劃的結果有助於未來危險分層篩檢之政策推行。 | zh_TW |
dc.description.abstract | Background: Community-based ultrasound screening for HCC is one of approaches to the prevention of hepatocellular carcinoma (HCC) for adults aged 30 years or older who had not the chance of receiving vaccination against hepatitis B virus infection. Weaimed to evaluate the mass screening for HCC with ultrasound in Changhua, Taiwan, one of areas with higher incidence of HCC.
Method: A total of 41412 residents aged 45-69 years attending the ChangHua Community-based Integrated Screening (CHCIS) constituted our study population. All participants were invited to screen in the light of four risk groups: extremely high (EH), high (H), intermediate (IM), and low (L). EH and H were classified by the median of risk score among those with positive HbsAg or anti-HCV or elevated alpha-fetoprotein level. IM and L were classified by the third quartile of the risk score among those with neither positive of the three markers. Participants were invited to an out-reaching screening program for HCC with ultrasound. We compared survival curves for those detected by ultrasound screening (ultrasound-detected), detected by two-stage method (two-stage screen-detected), and those diagnosed due to the appearance of clinical symptoms (clinically-detected). Proportional hazards regression model was used to assess the hazard ratios of risk for death from HCC by detection modes. We also calculated the adjusted hazard ratio considering lead-time bias. Prevalence pool was used to estimate the mean sojourn time (MST) in the four risk groups. Efficacy in terms of number-needed-to-screening (NNS) to avoid one interval cancer and NNS to avoid one HCC death was reported. Results: A total of 19 HCC were confirmed after ultrasound screening. Among them, 42.11% (n=8) had tumor size less than 3 cm, 47.3% (n=9) in 3-5 cm, and 10.53% (n=2) cases had tumor larger than 5 cm. Among the 19 ultrasound-detected cases (median follow-up time: 21.6 months), 2 (10.53%) died from HCC at 24 and 25 months. There were 24 two-stage screen-detected cases (median follow-up time: 37.3 months), of which 9 (37.5%%) died from HCC. Another 1165 clinically-detected were also identified, of which 798 (68.5%) died from HCC in a median follow-up time of 15.3 months. Compared with clinically-detected cases, the hazard ratios of HCC death were 0.15 (95% CI: 0.04-0.59) and 0.41 (95% CI: 0.21-0.78) for ultrasound-detected and two-stage screen-detected,respectively. The corresponding figures for lead-time bias adjusted hazard ratio was 0.31 (95% CI:0.12-0.84) and 0.63(95% CI 0.37-1.08), respectively. The mean sojourn time (MST) for EH, H, and IM were estimated as 1.10, 1.7, and 3.55 years, respectively. Three-monthly ultrasound screening could reduce 61% mortality from HCC for the EH group. The efficacy was reduced to 54% for 6-monthly screening, and 51% for 1-yearly screening. It was further reduced when the interscreening interval was further lengthened. Applying the current policy from the government, half-yearly ultrasound check-up for hepatitis B or C virus infection, it requires 4,383 and 37,547 ultrasounds to avoid one HCC death for EH and H groups. Conclusion: Ultrasound screening can detect small hepatocellular carcinoma with favor survival even after adjustment for lead-time bias. The out-reaching can also enhance yield of screening, even for those without positive for HBsAg or anti-HCV. The results of this program facilitate the policy for risk-stratification tailored screening in the future. | en |
dc.description.provenance | Made available in DSpace on 2021-05-20T20:58:14Z (GMT). No. of bitstreams: 1 ntu-100-P98842004-1.pdf: 653695 bytes, checksum: 63247d569c417fbf094f5a4d52bce058 (MD5) Previous issue date: 2011 | en |
dc.description.tableofcontents | 口試委員會審定書 i
誌謝 ii 中文摘要 iiii ABSTRACT v 目錄 viii 表目錄 ix 圖目錄 x 第一章 前言 1 1.1 研究背景 1 1.2 研究動機與目的 2 第二章 文獻回顧 3 2.1肝癌流行病學 3 2.2肝癌危險因子 4 2.3肝癌的預防 10 第三章 材料與方法 16 3.1社區肝癌防治 16 3.2危險分數分層 18 3.3以危險分數設定優先順序之篩檢邀約 19 3.4 篩檢效益之推估 20 3.5統計分析方法 22 第四章 結果 23 4.1超音波結果 23 4.2不同危險分層之平均滯留時間 (MST) 25 4.3不同偵測模式存活比較 25 4.4社區肝癌超音波篩檢效益 26 第五章 討論 28 5.1 以危險分數為導向的腹部超音波篩檢計畫 28 5.2 危險分數預測模式 29 5.3 平均滯留期的估計 30 5.4 篩檢效益推估 31 5.5 研究限制 32 5.6 結論 32 參考文獻 33 | |
dc.language.iso | zh-TW | |
dc.title | 危險分數分層導向之肝癌超音波篩檢效益評估 | zh_TW |
dc.title | The Efficacy of Risk-score Based Approach for Screening for Hepatocellular Carcinoma with Ultrasound | en |
dc.type | Thesis | |
dc.date.schoolyear | 99-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 張淑惠(Shu-Hui Chang),戴政(Jen Tai) | |
dc.subject.keyword | 肝癌,腹部超音波,社區整合式篩檢,危險分數分層,彰化縣, | zh_TW |
dc.subject.keyword | Hepatocellular carcinoma,Abdominal ultrasound screening,Risk-score stratification,Community-based Integrated Screening,Changhua, | en |
dc.relation.page | 55 | |
dc.rights.note | 同意授權(全球公開) | |
dc.date.accepted | 2011-07-27 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 流行病學與預防醫學研究所 | zh_TW |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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