目的：本研究利用來自同一個族群的全民健保資料分析，並以縱貫性世代研究分析接受不同早期乳癌手術患者的特性，以及接受不同手術治療與日後發生憂鬱/焦慮間之相關性。
方法：本研究利用乳癌（ICD-9-CM：174或A-code：A113）門診檔建立2000至2008年新發早期乳癌手術世代（n=36,377人），再以住院醫療費用清單明細檔，將患者依手術方式分區分為乳房切除未重建組（n=34,900人）、乳房切除立即重建組（n=1,080人）、及乳房切除延遲重建組（n=397人），除分析各手術樣本之病患特性與影響手術方式的因子外，同時研究三組樣本於2000至2010年間之焦慮/憂鬱症（ICD-9-CM：296、298、300、311或V79.0）診斷人數之發生密度；並以Cox多變量迴歸模式分析三組研究樣本發生焦慮/憂鬱症之相對危險性估計值；另一方面，本研究也以序位邏輯斯迴歸模式分析三組樣本焦慮/憂鬱症就醫頻率之相對危險性估計值。
結果：本研究發現，年齡、投保薪資級距、都市化程度、與術後接受輔助性化學性與放射線治療等因素都會影響患者選擇手術方式。經過最多11年的追蹤後，乳房切除未重建組、切除立即重建組、及切除延遲重建組之焦慮/憂鬱症之累積發生率分別為36.90%、41.56%、以及33.89%；而發生密度則是547.81（/1,000人年）與 634.92（/1,000人年）（立即重建與延遲重建合併），Cox迴歸分析發現，相對於未重建組，立即重建組與延遲重建組之焦慮/憂鬱症調整後危害對比值分別為1.06（95% CI=0.93-1.21）與1.17（95% CI=0.96-1.42）；此外，年齡較長、都市化程度較低、手術後罹患其他癌症、高就醫頻率者、以及患有某些慢性疾病之研究對象也有顯著較高的憂鬱/焦慮發生風險。多變量序位邏輯斯迴歸分析則是發現﹕手術方式與憂鬱/焦慮症就醫頻率之間並無顯著相關，立即重建組與延遲重建組之調整後勝算比分別為1.02（95% CI=0.88-1.18）與1.21（95% CI=0.91-1.51）；而會增加影響焦慮/憂鬱症發生頻率的因素則是包括，年齡較大、低都市化程度、手術後罹患有其他癌症、患有高血壓、慢性肺阻塞症、風濕性關節炎、缺血性心臟病、和中風之患者。
結論：本研究發現台灣新發早期乳癌手術患者選擇重建的比率並不高，社經指標與共病症都會影響病人選擇重建的決定，唯，重建與否並不會顯著影響早期乳癌手術病人日後發生憂鬱症/焦慮症的風險與就醫頻率。

Objectives: Using the National Health Insurance claim data of the same population, this study aimed to investigate characteristics of patients of early operated breast cancer, factors to Influence on the selection of the breast reconstruction, and the relationships between various operative methods and subsequent risks of anxiety and depression.
Methods: This study employed the breast cancer (ICD-9-CM: 174 or A-code: A113) ambulatory care visit data to set up the study cohort of breast cancer patient with early operation from 2000 to 2008 (n=36,377). Based on the inpatient claim data, we further classified the study cohort into three groups according to different operative methods, i.e., mastectomy alone (n=34,900), along with early reconstruction (n=1,080), and along with delayed reconstruction (n=397). We analyzed the characteristics of patients in relation to the choic of the operative methods. We also calculated the respective cumulative incidence rate and incidence density of anxiety and depression (ICD-9-CM: 296、298、300、311or V79.0) for the three study groups. Cox multivariate regression model was employed to estimate the relative risk estimates of anxiety and depression in relation to different operative methods. Additionally, ordinal logistic regression was used to calculate the relative risk estimates of ambulatory care visit frequency in relation to different operative methods.
Results: Our study noted that age, insurance preimium level, urbanization level, and post-surgery chemotherapy and radiotherapy were significantly associated with choice of operative methods in breast cancer patients with early stages. After up to 11 years of follow-up, the breast cancer patient with mastectomy alone, along with early reconstruction, and along with delayed reconstruction showed a cumulative incidence rate of 36.90%, 41.56%, and 33.89%, respectively; and a incidence density of 547.81 per 1,000 person-years and 634.92 per 1,000 person-years (combining groups of early and delay reconstruction), respectibvely. The Cox regression analysis indicated that compared to those with mastectomy alone, patients with early and delayed reconstructions experienced a hazard ratio (HR) of 1.06 (95% confidence interval (CI)=0.93-1.21) and 1.17 (95% CI=0.96-1.42), respectively for the occurrence of anxiety/depression. Additionally, a significantly higher HR was also noted for older ages, lower urbanization, secondary cancer post breast cancer surgery, higher ambulatioy care frequency, and suffering from certain chronic illnesses. The ordinal logistic regression analysis also reported no significant influences of operative methods on frequency of ambulatory care visit for anxiety/depression. The odds ratio (OR) of higher frequencies of ambulatory care visit for anxiety/depression for patients with early and delayed reconstruction was estimated at 1.02 (95% CI=0.88-1.18) and 1.21 (95% CI=0.91-1.51), respectively. The factors associated with an increased OR of higher frequencies of ambulatory care visit for anxiety/depression included older ages, lower urbanization, secondary cancer post breast cancer surgery, and with certain chronic illnesses such as hypertenstion, chronic obstructive pulmonary disease, rheumatoid arthritis, ischemia heart disease, and stroke.
. Operative methods had no infleunce on the psychosocial change.
Conclusion: This study found a low prevalence of reconstruction in operated breast cancer patients with early stages in Taiwan. Soco-economic variables and co-morbidities were associated with patient’s choice of reconstruction. We also noted that the incidence of and frequency of ambulatory care visit for anxiety/depression did not vary in patients with differet operative methods.

中文部分
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