簡易檢索 / 詳目顯示

研究生: 李艷林
Lee, Yen-Ling
論文名稱: 利用SEER資料庫來分析年輕及老年族群大腸癌患者的存活有無差別
Survival difference between young age and old age of colon cancer, SEER data based
指導教授: 李政昌
Lee, Jenq-Chang
學位類別: 碩士
Master
系所名稱: 醫學院 - 臨床醫學研究所碩士在職專班
Institute of Clinical Medicine(on the job class)
論文出版年: 2014
畢業學年度: 102
語文別: 英文
論文頁數: 49
中文關鍵詞: 大腸癌存活率年輕族群老年族群「流行病監測及最終結果/SEER」資料庫
外文關鍵詞: colon cancer, survival, young age, old age, SEER database
相關次數: 點閱:174下載:2
分享至:
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報
  • 大腸直腸癌在美國為癌症死因的第二位,對病人日後的生活品質往往造成很大的影響,它大多發生在年紀大於六十五歲的病人身上,而我們的人口正在老化當中,老化會使各種組織對癌化的感受性增加並加速癌化的進展及惡化,然而大約有20%左右的病人具有家族聚集及一等親罹癌或有大腸良性腺癌的病史,這類族群的患者通常年紀較輕且可能具有不同的基因型表現。大腸直腸癌年輕病患和年老病患的預後到底是否相同目前仍有爭議,我們以五十歲做為區分年輕和年老族群的分界點,利用美國國家癌症研究院的「流行病監測及最終結果/SEER」資料庫來對年輕及年老族群的大腸癌做存活分析,收集自西元1995年至2008年被診斷為大腸癌且其病理診斷為惡性腺癌的病患共261523位,其中129969(49.7%)位為男性,131554(50.3%)位為女性,追蹤中位數時間為32個月,計算各個期別中位數存活時間及5年存活率並做比較,其中年老族群(>50歲)佔91.7%,年輕族群(<=50歲)佔8.3%,年老族群得到大腸癌的機率比起年輕族群高9倍,年老族群的平均年齡為72.50歲,年輕族群的平均年齡為43.74歲,性別在這兩個族群上對於是否會得到大腸癌都沒有差異,年老族群的大腸癌通常以右側結腸癌居多。相較於年輕乳癌患者的診斷時期別通常在末期且存活率較低,年輕族群大腸癌的患者其存活率在各個期別都比年老族群高,推測可能是因有較少的共病及較好的身體狀況足以面對癌症的各種治療所致。

    Colorectal cancer is the second leading cause of cancer death in the United States and is an important contributor to cancer morbidity. The majority of patients with colorectal cancer (CRC) are older than 65 years, and our population is aging. Aging may increase the susceptibility of various tissues to initiation of carcinogenesis and facilitates promotion and progression of carcinogenesis. However, about 20% of patients of colorectal cancer are associated with familial clustering and first-degree relatives of patients with colorectal adenomas or invasive colorectal cancer are at risk for colorectal cancer. This group of patients are general younger and may have different genomic expression. Whether the prognosis of young age and old age in colon cancer are the same is still debated. We used Surveillance, Epidemiology, and End Results Program (SEER) database to study survival difference between young age and old age of colon cancer. Patients diagnosed with colon cancer from the SEER database (1995-2008) were analyzed. Only adenocarcinoma was included. A total of 261,523 patients with a median follow-up of 32 months were included. The cutoff point of age is 50 years. Median survival and 5-year survival rate of patients with the same stage of young and old group were evaluated. The colon cancer study group included 129,969 men (49.7%) and 131,554 women (50.3%). Of the 261,523 patients with colon cancer, 91.7% are old age and 8.3% are young age. The colon cancer incidence of old age was 9 times greater than the young age incidence. Mean age of the older group patients was 72.5 years and 43.74 years for young group. The gender ratio among colon cancer in young group was similar with old group. The right site tumors are more common in old group. Unlike women with breast cancer that young women generally face more aggressive stages and lower survival rates, patients diagnosed with colon cancer of young group have better survival than old group in all stages possible due to less comorbidities and better tolerance to treatment.

    目錄 英文摘要…………………………………………………………………….1 中文摘要…………………………………………………………........3 誌謝………………………………………………………………………….5 目錄…………….……………………………………………………………6 表目錄……….……………………………………………………………..8 圖目錄……………………………………………………………………….9 縮寫指引…………………………………………………………………..10 主文………………………………………………………………………..12 參考文獻…………………………………………………………………..42 附錄………………………………………………………………………..47 自述………………………………………………………………………..49 INDEX I. Introduction 1. Colorectal Cancer……………………………………………………….......12 2. Surveillance, Epidemiology, and End Results database…………...18 3. Aims and Significance……………………………………………………....19 II. Materials and Methods…………………………………………………………..19 III. Statistical Analysis…………………………………………………………......20 IV. Results 1. Patient Characteristics…………………………………………………...21 2. Survival………………………………………………………………….............23 V. Discussion…………………………………………………………………….........23 VI. Limitations……………………………………………………………………........28 VII. Conclusion……………………………………………………………………............29 VIII. Future Work………………………………………………………………….........29 IX. Table………………………………………………………………………………..........30 X. Figure……………………………………………………………………………..........38 XI. Reference…………………………………………………………………………........42 XII. Appendix…………………………………………………………………………............47

    1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin 2013;63:11-30.
    2. Cheng L, Eng C, Neiman LZ, et al. Trends in Colorectal Cancer Incidence by Anatomic Site and Disease Stage in the United States From 1976 to 2005. Am J Clin Oncol 2011.
    3. Siegel T, Ward E, Brawley O, Jemal A. Cancer statistics, 2011: The impact of eliminating socioeconomic and racial disparities on premature cancer deaths. CA Cancer J Clin 2011.
    4. Heald RJ, Ryall RD. Recurrence and survival after total mesorectal excision for rectal cancer. Lancet. 1986;1(8496): 1479-1482
    5. Andre T, Boni C, Mounedji-Boudiaf L, Navarro M, Tabernero J, Hickish T, Topham C, Zaninelli M, Clingan P, Bridgewater J, Tabah-Fisch I, de Gramont A. Oxaliplatin, fluorouracil, and leucovorin as adjuvant treatment for colon cancer. The New England journal of medicine 2004;350:2343-51.
    6. The Cancer Genome Atlas Research Network. Comprehensive genomic
    characterization of human colon and rectal cancer. Nature 2012;487, 330-337.
    7. SEER*Stat Database: Incidence - SEER 17 Regs Limited-Use + Hurricane Katrina Impacted Louisiana Cases, Nov 2009 Sub (2000-2007) <Katrina/Rita Population Adjustment> - Linked To County Attributes - Total U.S., 1969-2007 Counties [computer program]: Surveillance, Epidemiology, and End Results (SEER) Program (www.seer.cancer.gov), National Can¬cer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, released April 2010, based on the November 2009 submission.
    8. Toren Finkel, Manuel Serrano & Maria A. Blasco, The common biology of cancer and ageing, NATURE, Vol 448,16 August 2007
    9. Hemminki K, Chen B. Familial risk for colorectal cancers are mainly due to heritable causes. Cancer Epidemiol Biomarkers Prev 2004;13:1253-1256.
    10. Ahsan H, Neugut AI, Garbowski GC, et al. Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med 1998;128:900-905.
    11. Bonelli L, Martines H, Conio M, et al. Family history of colorectal cancer as a risk factor for benign and malignant tumours of the large bowel. A case-control study. Int J Cancer 1988;41:513-517.
    12. Lynch HT, de la Chapelle A. Hereditary colorectal cancer. N Engl J Med 2003;348:919-932.
    13. Marra G, Boland CR. Hereditary nonpolyposis colorectal cancer: the syndrome, the genes, and historical perspectives. J Natl Cancer Inst 1995; 87: 1114
    14. Ribic CM, Sargent DJ, Moore MJ, et al. Tumor microsatellite-instability status as a predictor of benefit from fluorouracil-based adjuvant chemotherapy for colon cancer. N Engl J Med. 2003; 349(3): 247-257
    15. Huxley RR, Ansary-Moghaddam A, Clifton P, et al. The impact of dietary and lifestyle risk factors on risk of colorectal cancer: a quantitative overview of the epidemiological evidence. Int J Cancer 2009;125:171-180.
    16. Alici S, Aykan NF, Sakar B, Bulutlar G, Kaytan E, Topuz E. Colorectal cancer in young patients: characteristics and outcome. Tohoku J Exp Med 2003;199:85-93.
    17. Rex DK, Johnson DA, Anderson JC, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2009. Am J Gastroenterol 2009;104:739-750.
    18. Sanabria A, Carvalho AL, Vartanian JG, et al. Comorbidity is a prognostic factor in elderly patients with head and neck cancer. Ann Surg Oncol 2007;14:1449-1457.
    19. Yen-Chien Lee, Yen-Ling Lee, Jen-Pin Chuang, Jenq-Chang Lee. Differences in Survival between Colon and Rectal Cancer from SEER Data. PLoS ONE 2013; 8(11)
    20. O’Connell JB, Maggard MA, Liu JH, Etzioni DA, Livingston EH, Ko CY. Rates of colon and rectal cancer are increasing in young adults. Am J Surg 2003;69:866-72.
    21. O’Connell JB, Maggard MA, Livingston EH, Yo CK. Colorectal cancer in the young. Am J Surg 2004;187:343-8.
    22. Chung YF, Eu KW, Machin D, Ho JM, Nyam DC, Leong AF, Ho YH, Seow-Choen F. Young age is not a poor prognostic marker in colorectal cancer. Br J Surg 1998;85:1255-9.
    23. Liang JT, Huang KC, Cheng AL, Jeng YM, Wu MS,Wang SM. Clinicopathological and molecular biological features of colorectal cancer in patients less than 40 years of age. Br J Surg 2004;90:205-14.
    24. Dr. Emmanuel Mitry M.D., Anne-Marie Benhamiche M.D., Jean-Louis Jouve M.D., François Clinard Pharm.D., Corinne Finn-Faivre M.D., Jean Faivre M.D. Colorectal adenocarcinoma in patients under 45 years of age: comparison with older patients in a well-defined French population. Dis Colon Rectum. 2001 Mar;44(3):380-7.
    25. A. Torsello, C. Garufi, M. Cosimelli, et al. P53 and bcl-2 in colorectal cancer arising in patients under 40 years of age: Distribution and prognostic relevance. European Journal of Cancer 2008; 44( 9): 1217–1222
    26. Chun-Yu Fu, Shu-Wen Jao, Chang-Chieh Wu, Chia-Cheng Lee, Tsai-Yu Lee, Huai-En Lu, Cheng-Wen Hsiao. Comparisons of Characteristics and Outcome of Colorectal Cancer in Different Age Categories: A Retrospective Analysis of a Single Institution in Taiwan. J Soc Colon Rectal Surgeon (Taiwan) 2011;22:57-64
    27. Marble K, Banerjee S, Greenwald L. Colorectal carcinoma in young patients. J Surg Oncol 1992;51:179-82.
    28. Qingguo Li, Changhua Zhuo, Guoxiang Cai, et al. Pathological Features and Survival Outcomes of Young Patients with Operable Colon Cancer: Are They Homogeneous? PLoS ONE 2014

    下載圖示 校內:立即公開
    校外:立即公開
    QR CODE