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標題: | 年輕族群接受免疫糞便潛血篩檢對大腸直腸癌之影響 The Effect of Fecal Immunochemical Test-based Screening on Colorectal Cancer in Young Adults |
作者: | Liang-Wei Tseng 曾亮瑋 |
指導教授: | 陳秀熙(Hsiu-Hsi Chen),邱瀚模(Han-Mo Chiu) 陳秀熙(Hsiu-Hsi Chen | chenlin@ntu.edu.tw | ),邱瀚模(Han-Mo Chiu | hanmochiu@ntu.edu.tw | ), |
關鍵字: | 年輕族群,大腸癌篩檢,免疫糞便檢查,大腸癌發生率,篩檢年齡, Young adults,Colorectal Cancer(CRC) screening,Fecal immunochemical test (FIT),Colorectal Cancer (CRC) incidence,Screening age, |
出版年 : | 2022 |
學位: | 碩士 |
摘要: | 背景: 我們已了解對於年滿50歲民眾進行免疫糞便大腸癌篩檢可以降低大腸癌的發生率及死亡率。近年來,年輕族群的大腸癌發生率在全球都有上升的趨勢。然而,對於降低篩檢起始年齡目前還有待釐清。整合式社區篩檢從2001年開始,包含了年滿40歲就進行免疫糞便篩檢的民眾。這比目前台灣現行的大腸癌免疫糞便篩檢年齡下降了10歲。因此我們納入社區篩檢中之A地區做分析。目標是希望利用社區篩檢的資料來評估是否降低免疫糞便檢查的起始年齡對是否發生大腸癌的影響。 材料與方法: 由社區篩檢資料庫內年滿40至49歲民眾,於2003年至2009年間在A地區有接受免疫糞便篩檢者納入分析。再連結至台灣大腸癌篩檢及癌登資料庫進行進一步分析。根據篩檢起始年齡區分成40歲開始以及年滿50歲開始篩檢。結果會連接至國家癌症登記檔及死亡檔來確定大腸癌的診斷,追蹤至2019年。主要結果以糞便篩檢陽性率、腺瘤偵測率、進行性腺瘤偵測率、大腸直腸癌偵測率及癌症期別分布。大腸癌發生率與死亡率會以每十萬人年計算及表示,發生風險對比值(hazard ratio)則以多變數回歸分析(multivariate regression analysis)來做計算,並進行性別、出生年齡及家族史的調整。 結果: 總共有5萬2636人參與篩檢計畫,最終接受納入篩檢分析者,其中男性有2萬2994人而女性有2萬9642人。免疫糞便潛血檢查之陽性率、腺瘤偵測率、進行性腺瘤偵測率與大腸直腸癌偵測率為男性、年滿50歲篩檢者及大腸直腸癌家族史較高。年齡介於40至49歲間,接受篩檢者與未篩檢者各為1萬5615人與3萬7021人。後續大腸直腸癌發生率為每十萬人年17.2人與每十萬人年21.1人。 其中男性、出生年齡層高(1954-1959)以及有家族史者發生率會更高。然而,在進行多變數回歸分析中,調整年齡、性別、家族史後,相對於未篩檢組,調整後的風險對比值在篩檢組對於大腸直腸癌的發生為0.89(95%信賴區間為0.65~1.21),不具有統計顯著性。將男性與女性篩檢的累積發生率區分開來,可以發現男性的大腸癌累積發生率在篩檢組有下降的趨勢,但未達統計顯著(風險對比值=0.75,95%信賴區間為0.47~1.20)。若將下降至45歲開始篩檢與從40歲開始篩檢來做比較,也並無統計顯著差異(風險對比值=0.90,95%信賴區間為0.47~1.72)。此外,未篩檢組具有更多比例的第四期大腸直腸癌與較高的死亡率。 結論: 根據分析結果顯示,如果使用免疫糞便潛血檢查對於大腸直腸癌篩檢起始年齡從小於50歲開始,有可能可降低後續發生大腸癌及因大腸癌死亡的機會,但仍需更多資料研究證實。 Background Screening for colorectal cancer (CRC) in adults ≥ 50 years of age can result in a reduction in the incidence and mortality of CRC. The incidence of CRC among young adults increased in many countries. However, the impact of CRC screening starting at age 40 years is still not clear. The multiple disease community-based integrated screening program was initiated in 2001, and fecal immunochemical test (FIT) was offered to the population older than 40 years old for colorectal cancer. The starting age of screening was younger than the Taiwan Colorectal Cancer Screening by 10 years. The aim of the study is to evaluate the effect of CRC screening starting at age 40 years in the colorectal cancer screening program. Material and method The subjects aged 40 to 49 years from 2003 through 2009 in A community who were invited to attend the FIT-based community screening project were enrolled. The database of the community screening program was linked with the Taiwan Colorectal Cancer Screening Program. The subjects who participated in at least one FIT screening comprise the study cohort. The positivity rate of FIT, detection rate of adenoma, advanced adenoma and colorectal cancer were analyzed and compared by gender, age at entry screening and family history. The participants were categorized into two groups according to the screening or non-screening at aged 40 to 49years old. The overall incidence, mortality, incidence between different gender, birth year and family history of CRC in screening group versus non-screening group were also compared. The cohort was linked to the National Cancer Registry and the National Death Registry for identifying the diagnosis of CRC until 2019. The stages of CRC of screening or non-screening at aged 40 to 49 years old were calculated. The incidence of colorectal cancer was calculated and expressed as CRC per 100,000 person-years of observation from each group. Multivariate regression analysis were conducted adjusting for age, gender and family history to evaluate the hazard ratio of incidence and mortality of colorectal cancer. Results Of the 52,636 subjects who participated in at least one FIT screening within the entire cohort. A total of 22,994 male and 29,642 female subjects were screened. The positivity rate of FIT, detection rate of adenoma, advanced adenoma and CRC were higher in male, older starting screening age and those who have family history of CRC. The subjects who were screened or non-screened at the age 40-44 years is 1,5615 and 3,7021 respectively. The incidence of subsequent colorectal cancer was 17.2 per 100,000 person-year and 21.1 per 100,000 person-year, respectively. The incidence also higher in male, younger birth group (1960-1966) and family history of CRC. In the multivariate regression analysis, after adjusting for age, gender and family history, compared with non-screening group, the adjusted hazard ratio (aHR) for subsequent CRC was 0.89 (95%CI= 0.75~0.98) for the screening group, may associated with decreased incidence of CRC, but were not statistically significant. Subgroup analysis according to gender (male or female) or starting screening age (40-44 or 45-49) were performed but still no statistically significant. In male group, aHR for subsequent CRC was 0.75 (95%CI= 0.47~1.20) for the screening grou. In starting screening age between 40 to 44, compared with age 45-49, aHR for subsequent CRC was 0.90 (95%CI= 0.47~1.72) for the screening group. In addition, compared two groups, the non-screening group have more stage 4 CRC and higher mortality rate than screening group. Conclusions In conclusion, the population who started to undergo CRC screening before 50 years old had lower possibility to develop subsequent CRC than those after 50 years. But more research evidence is needed. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/84565 |
DOI: | 10.6342/NTU202203702 |
全文授權: | 同意授權(限校園內公開) |
電子全文公開日期: | 2022-10-13 |
顯示於系所單位: | 公共衛生碩士學位學程 |
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