子宮頸癌患者癌症篩檢與預後之相關

Abstract

子宮頸癌2020年為全球婦女常見癌症第四名, 全球約有604,000例子宮頸癌新發個案, 341,000例死亡個案｡ 本研究使用臺灣癌症登記中心2009年1月至2013年12月的子宮頸癌資料｡ 並利用Kaplan-Meier法計算子宮頸癌個案診斷罹癌後的五年存活機率, 以及使用Cox regression 模型評估篩檢史與子宮頸癌預後之間的關聯｡ 我們發現, 曾經篩檢過的子宮頸癌病患相較於從未篩檢的子宮頸癌病患, 罹癌後有較佳的存活情形, 並發現即使是在相同癌症期別下, 亦有著相同的情形｡ 本研究更進一步發現不同篩檢史病患子宮頸癌死亡風險更細緻的分層: 篩檢陽性且半年內確診 < 篩檢陽性且超過半年確診或篩檢陰性< 從未篩檢｡ 即使調整干擾因子 (包括癌症期別及是否接受治療), 風險分層仍然存在, 校正後風險比(95%信賴區間)依序為1.00, 1.42(1.27-1.60), 1.62(1.43-1.82)｡ 這表示篩檢史可能是子宮頸癌病患獨立的預後因子｡

Cervical cancer is the fourth most common cancer among women in the world in 2020. There are approximately 604,000 new cases of cervical cancer and 341,000 deaths worldwide. Cervical cancer data were abstracted from Taiwan Cancer Registry from January 2009 to December 2013. We used the Kaplan-Meier method to calculate the five-year survival rate after the cervical cancer diagnosis and the Cox regression model to evaluate the association between screening history and cervical cancer prognosis. We found that those who had been screened, compared with those who had never screened, had better survival even in the same cancer stage. Our study further found a more nuanced stratification of the risks of cervical cancer death: {screening positive and diagnosed within six months} < {screening positive and diagnosed more than six months or screening negative} < {never screened}. The risk stratification remains despite adjusting for confounding factors (including cancer stage and whether the patients received treatment). The adjusted hazard ratios (95% confidence intervals) are 1.00, 1.42(1.27-1.60), and1.62(1.43-1.82), respectively. Our study suggests that screening history may be an independent prognostic factor for cervical cancer patients.