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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 簡國龍(Kuo-Liong Chien) | |
dc.contributor.author | Chien-Hua Chen | en |
dc.contributor.author | 陳建華 | zh_TW |
dc.date.accessioned | 2021-06-15T02:42:43Z | - |
dc.date.available | 2014-09-16 | |
dc.date.copyright | 2009-09-16 | |
dc.date.issued | 2009 | |
dc.date.submitted | 2009-08-10 | |
dc.identifier.citation | References
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dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/44161 | - |
dc.description.abstract | 背景與目的: 侵犯性攝護腺癌患者接受雄性激素剝奪療法的預後差異性很大,造成在病人諮詢上的困難。本研究目的在確認影響侵犯性攝護腺癌患者發生化惡化的預後因子。
方法:從台灣北部兩所醫學中心電腦登錄系統回溯性地查詢於1995年11月到2008年4月曾經使用leuprorelin acetate (Leuplin Depot®, 3.75 mg)治療攝護腺腺癌的病患。共有107位符合初診斷為侵犯性(cT3 以上)或是轉移性攝護腺癌的病人接受評估影響發生生化惡化與總存活的相關因子。所有病患都有檢測初始血清攝護腺特定抗原 (prostate specific antigen, PSA)。並以Cox 回歸模型以及 Kaplan-Meier 分析來評估臨床因子與發生生化惡化的關係。 結果:病人年齡的中位數是74.6 歲。初始血清攝護腺特定抗原的中位數則是 105 ng/mL(Q1-Q3 為39.8至372 ng/mL)。在追蹤時間的中位數為46.1個月這段期間,總共有54位病人 (50.5%) 有發生生化惡化的情形。在多變項分析中,初始血清PSA值大於105 ng/mL (相對危險比, RR, 3.23; 95% 信賴區間, 95% CI, 1.66, 6.29)、病理性骨折 (RR, 2.73; 95% CI, 1.37, 5.44)、以及血色素濃度小於或是等於12.7 g/dL (RR, 2.05; 95% CI, 1.10, 3.81) 是影響發生生化惡化的預後因子。與血清PSA最低三分位分組比較,在血清PSA最高三分位分組的病人,經校正年齡以及身體質量指數,發生生化惡化的危險比超過三倍 (RR, 3.16, 95% CI, 1.38, 7.22). 進一步校正攝護腺體積、診斷方式、Gleason 分數、是否有骨骼轉移以及病理性骨折,稍微減弱了發生生化惡化的危險比。再進一步校正血色素以及臨床疾病狀態,發生生化惡化的危險比依然顯著(RR, 3.68, 95% CI, 1.33, 10.0). 結論:本研究顯示初始血清PSA濃度的高低確實可以做為影響台灣侵犯性攝護腺癌患者發生生化惡化的危險因子。 | zh_TW |
dc.description.abstract | Background and Objectives: The prognosis of men with advanced prostate cancer receiving androgen deprivation therapy is highly variable, and it is difficult to counsel a man who is in non-curative treatments. The aim of this study is to identify prognostic factors affecting biochemical progression (BCP) of advanced prostate cancer patients in Taiwan.
Methods: Working with 2 medical centers within north Taiwan, a cohort of men diagnosed with prostate adenocarcinoma ever receiving leuprorelin acetate (Leuplin Depot®, 3.75 mg) between November 1995 and April 2008 was collected from the computerized registry system of the two medical centers. A total of 107 eligible patients with newly diagnosed advanced (cT3 above) or metastatic prostate cancer were assessed for the development of BCP and overall survival. All men had initial serum prostate specific antigen (PSA) measurements. Cox regression model and Kaplan-Meier analysis were used to evaluate the relationship between the clinical parameters and the BCP. Results: The median age of the included men was 74.6 years. The median value of initial PSA was 105 ng/mL (Q1-Q3, 39.8 to 372 ng/mL). A total of 54 patients (50.5%) had BCP during a median 46.1 months’ follow-up. In a multivariate analysis, initial serum PSA greater than 105 ng/mL (relative risk [RR], 3.23; 95% confidence interval [CI], 1.66, 6.29), pathological bone fracture (RR, 2.73; 95% CI, 1.37, 5.44), and hemoglobin 12.7 g/dL or less (RR, 2.05; 95% confidence interval, CI, 1.10, 3.81) were prognostic factors of BCP. As compared with those in the lowest tertile, participants in the highest tertile of initial PSA had nearly 3 times the age and body mass index (BMI)-adjusted risk of BCP (RR, 3.16; 95% CI, 1.38, 7.22). Further adjustment for prostate volume, method of diagnosis, Gleason score, bone metastasis and pathologic bone fracture slightly attenuated the risk. However, after adjusting for hemoglobin and the clinical diseases, the relative risk of developing BCP remained significant (RR, 3.68; 95% CI, 1.33 to 10.0). Conclusions: Our data demonstrate that initial serum PSA is a significant risk factor for BCP for Taiwanese advanced prostate cancer patients. | en |
dc.description.provenance | Made available in DSpace on 2021-06-15T02:42:43Z (GMT). No. of bitstreams: 1 ntu-98-R96846010-1.pdf: 741230 bytes, checksum: 560c9ccfd43f0ce05d13131d3ba7e51b (MD5) Previous issue date: 2009 | en |
dc.description.tableofcontents | 致謝 I
中文摘要 II ABSTRACT III 內容綱要 (Table of Contents) V FIGURES VII TABLES VIII 第一章 緒論 1 第一節 前言 1 第二節 研究動機 3 第二章 文獻探討與研究目的 5 第一節 攝護腺癌的臨床表徵 5 第二節 攝護腺特定抗原 6 第三節 攝護腺癌的診斷 8 2-3-1 血清攝護腺特定抗原濃度上升超過正常範圍 8 2-3-2 直腸指檢攝護腺有異常的情形 11 2-3-3 攝護腺切片 12 2-3-4 攝護腺癌的病理組織診斷 12 2-3-5 Gleason分數 (Gleason Score) 13 第四節 攝護腺癌的分期 14 2-4-1 TNM的腫瘤分期系統 14 2-4-2 腫瘤的侵犯程度 (Local extension, T) 14 2-4-3 局部淋巴結侵犯與否的評估 (Regional lymph nodes, N) 15 2-4-4 遠處轉移與否的評估 (Distant metastases, M) 18 第五節 攝護腺癌的治療 20 2-5-1 早期攝護腺癌的治療 20 2-5-2 局部侵犯性攝護腺癌的治療 24 2-5-3 侵犯性攝護腺癌的治療 29 2-5-4 荷爾蒙治療失效的轉移性攝護腺癌 32 第六節 預測因子的探討 34 第七節 研究目的 39 第三章 材料與方法 40 第一節 研究流程 40 3-1-1 問題形成與研究假說 40 3-1-2 文獻回顧 42 3-1-3 資料收集 42 3-1-4 資料分析與模型建立 42 第二節 資料收集 43 3-2-1 研究病人的選取與排除條件 43 3-2-2 病人確定診斷時的臨床資料與變項的定義 44 3-2-3 研究終點 (Endpoint)的定義 48 3-2-4 其它病人治療追蹤過程中臨床資料的記錄 49 第三節 統計方法與資料分析 50 3-3-1 基本資料的描述 50 3-3-2 以初始血清PSA濃度高低為主要效應 (Main effect) 51 3-3-3 單變項的回歸分析 51 3-3-4 自變項的相關性分析 52 3-3-5 多變項的回歸分析 53 3-3-6 生化惡化發生率的計算以及模型進行干擾因子的校正 53 3-3-7 生化惡化的Kaplan-Meier分析 54 第四章 研究結果 55 第一節 研究個案的基本資料描述 55 第二節 研究個案治療追蹤的結果 56 第三節 依初始血清PSA濃度高低分組的基本資料比較 56 第四節 單變項Cox回歸分析的結果 57 第五節 自變項的相關係數性分析 57 第六節 多變項Cox回歸分析的結果 58 第七節 生化惡化發生率與校正干擾因子後的模型 59 第八節 發生生化惡化的Kaplan-Meier分析 60 第五章 討論 63 第一節 研究族群追蹤結果描述性統計的討論 63 第二節 三個不同初始血清PSA濃度分組的討論 66 第三節 影響生化惡化的單變項Cox回歸分析 66 第四節 多變項Cox回歸分析的顯著影響因子 70 第五節 生化惡化發生率與校正干擾因子後的模型 70 第六節 研究的強度 (Strength) 71 第七節 研究的限制 71 第八節 結論 72 參考文獻 73 | |
dc.language.iso | zh-TW | |
dc.title | 以攝護腺特定抗原做為侵犯性攝護腺癌患者接受荷爾蒙療法後發生生化惡化的預後因子之研究 | zh_TW |
dc.title | Prostate Specific Antigen as a Prognostic Factor for Biochemical Progression of Advanced Prostate Cancer Patients Receiving Hormone Treatment | en |
dc.type | Thesis | |
dc.date.schoolyear | 97-2 | |
dc.description.degree | 碩士 | |
dc.contributor.coadvisor | 張宏江(Hong-Chiang Chang) | |
dc.contributor.oralexamcommittee | 陳世乾,程蘊菁,李文宗 | |
dc.subject.keyword | 攝護腺癌,生化惡化,攝護腺特定抗原,預後因子, | zh_TW |
dc.subject.keyword | prostate cancer,biochemical progression,prostate specific antigen,prognostic factor, | en |
dc.relation.page | 124 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2009-08-11 | |
dc.contributor.author-college | 公共衛生學院 | zh_TW |
dc.contributor.author-dept | 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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