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[[alternative]]Risk Factors for Bowel Obstruction and Effect of Survival on Newly Diagnosed Colorectal Cancer Patients: An Example of 2000–2009 Colorectal Cancer Cohort

By 葉恩惠 and Yeh Ann

Abstract

[[abstract]]目標:腸阻塞是結直腸癌手術後最常見的併發症,會增加病患死亡風險。本回溯性世代研究主要探討結直腸癌病患術後1年內併發腸阻塞的發生情形及其危險因子,並檢視術後新併發腸阻塞對結直腸癌病患存活的影響。方法:研究對象為1997-2010年全民健康保險研究資料庫中擷取2000到2009年間新診斷為結直腸癌的病患。以卜瓦松迴歸分析腸阻塞的發生密度及其危險因子。經邏輯斯迴歸計算每名個案「年齡」與「性別」與併發腸阻塞關係的傾向分數,匹配有/無併發腸阻塞的患者後,以AFT model分析有/無併發腸阻塞對結直腸癌術後30天及1年內死亡風險的影響。結果:2000–2009年新發結直腸癌世代共有45,371人,術後一年併發腸阻塞之累積發生率為7.93%,發生密度為8.56/ 100個人年,其中第一個月發生密度為20.21/ 100個人年遠高於其他時間點。結直腸癌術後1年內併發腸阻塞的預測因子有年齡(adjusted incidence rate ratio [adjusted IRR] = 1.06,≧75 歲比<45 歲,95%CI [1.04-1.06]),性別(adjusted IRR = 1.09,男性比女性,95%CI [1.08-1.09]),手術方式(adjusted IRR = 1.01,直腸切除術比結腸切除術,95%CI [1-1.02]),手術時有輸血(adjusted IRR = 1.04,有比無,95% CI = 1.41-1.45),醫師年平均手數量(adjusted IRR = 1.11,高比極低,95% CI [1.09-1.12])。以 AFT model 分析,有併發腸阻塞會降低結直腸癌病患術後30天死亡風險(adjusted IRR = .24, 95 CI [.08- .72]),但會增加術後1年死亡風險(adjusted RR= 2.72, 95% CI [1.05–1.72])。結論:術後1年內約有7.93%結直腸癌病患會併發腸阻塞,且好發在術後第一個月,而併發腸阻塞會增加術後1年內的死亡風險。本研究結果可供臨床人員即早針對併發腸阻塞高風險病患,加強監測並治療;在研究方面,可作為未來預防及治療臨床試驗中選擇合適研究對象的參考。[[abstract]]Objectives: Bowel obstruction (BO) is the most common complication after resection of colorectal cancer. The aim of this retrospective cohort study was to investigate the incidence and risk factors for BO in patients who had undergone resection for colorectal cancer and to evaluate the effect of developing a new BO on survival for patients with colorectal cancer. Methods: Patients who were diagnosed as colorectal cancer between 2000 and 2009 were retrieved from the Taiwan’s National Health Insurance Research Database in 1997-2010. The incidence and the risk factors associated with BO were determined by Poisson regression. Propensity score matching was used to select patient with and without BO by accounting for the covariates of age and gender. Accelerated Failure Time Model (AFT) was employed to estimate the 30-day and 1-year mortality hazard difference between patients with and without BO (rate ratio).Results: Among 45,371 newly diagnosed colorectal cancer in 2000-2009, the 1-year cumulative bowel obstruction incidence was 7.93% (8.56 events/100 patient-years), with a rate of 20.21 events/100 patient-years during the first month. Statistically significant independent predictors of developing BO within 1-year were age (adjusted incidence rate ratio[adjusted IRR],1.06 if ≧75 years v<45; 95%CI [1.04-1.06]), gender (adjusted IRR, 1.09 if men v female; 95%CI [1.08-1.09]), type of surgery (adjusted IRR, 1.01 if rectal resection v colon resection; 95%CI [1-1.02]), perioperative transfusion (adjusted IRR, 1.04 if yes v no; 95%CI [1.03-1.05]), and surgeon annual case volume (adjusted IRR, 1.11 if high v extreme low; 95%CI [1.09-1.12]). In AFT model analysis, BO was a significant predictor of decreased 30-day mortality (adjusted RR, .24, 95 CI [.08- .72]), but increased 1-year mortality (adjusted RR, 2.72, 95%CI [1.05–1.72]).Conclusions: Approximately 7.93% of colorectal cancer patients developed BO within 1-year, with the highest incidence in the first month after surgery. The diagnosis of BO was associated with a higher risk of death within one year. These features can be used to health professionals to patients likely to experience BO after bowel resection so that they can be monitored early in the postoperative period and available treatments targeted toward them. The results may be useful in the research context to facilitating the more efficient selection of high-risk patients as subjects on clinical trials of prevention of treatment

Topics: 存活;發生密度;腸阻塞;結直腸癌;加速失敗時間模型, survival; incidence rate;bowel obstruction;colorectal cancer;Accelerated Failure Time Model, [[classification]]14
Publisher: 國立台北護理健康大學健康事業管理研究所
Year: 2014
OAI identifier: oai:NTUNHSIR:987654321/3448
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