| Summary: | 碩士 === 高雄醫學大學 === 醫務管理暨醫療資訊學系碩士在職專班 === 103 === Background and Purpose
Colorectal cancer (colorectal cancer, CRC) is one of the world''s most common cancer, accounting for 9% of global cancer incidence, the rate of early detection of domestic only 10%, 35% found cancer has been transferred. The cancer treatment advances, along with advances in medical technology and techniques, but also need to explore a lot of medical manpower, material resources arising from consumption, whether for the prognosis of colorectal cancer patients have reached the desired effect. This study focuses on surgery for colorectal cancer patients receiving chemotherapy with or without its demography, cancer characteristics and treatment characteristics of the case, to relapse, the overall survival of the effects of different chemical treatment mode, with or without receiving effects of chemical treatment on the consumption of medical resources, chemotherapy integrity or not to relapse, overall survival and consumption of medical resources affected.
Methods
This study is a retrospective study. Received a text object for the southern medical centers, ending January 2005 to December 2011 31 at the hospital diagnosed cases primary colorectal cancer (ICD_9_CODE: 153-154) of the patient, and accept the initial colorectal resection surgery patients as a sample. Research Sources have medical record review, the hospital medical expenses declaration stalls, Executive Yuan Wei Hattori death database files, the hospital''s cancer registration profile. Use SPSS 20.0 statistical software for independent samples T test, one-way analysis of variance, chi-square test, COX proportional hazards regression, linear regression analysis, logistic regression data analysis.
Results
The average age at surgery for colorectal cancer patients was 64.89 years, while the number of times the average hospital stay 17.64 ± 9.9 days, and when the second medical costs 161,101 ± 97,340 yuan, postoperative adjuvant chemotherapy recurrence ratio is higher than 68% of patients without recurrence, AJCC staging first Ⅲ chance of recurrence are 0 ~Ⅰ period of 3.88 times (OR: 3.88,95% CI = 1.66 ~ 9.07). Have the opportunity to peripheral nerve recurrent violations are no violations of the peripheral nerve 1.68 times (OR: 1.68,95% CI = 1.14 ~ 2.47). Compared to receive adjuvant chemotherapy after death situations, surgery patients aged ≧ 75 years is <65 years of 1.77 times (OR: 1.77,95% CI = 1.26 ~ 2.50). AJCC staging of the first Ⅲ risk of death is the first 0 ~Ⅰ of 1.75 times (OR: 1.75,95% CI = 1.02 ~ 3.01). Using part of medical resources, AJCC stage, lymph node involvement have significant differences (P <0.001, P = 0.003), AJCC staging worse then spend the more medical costs. The AJCC staging of the first Ⅲ complete acceptance of postoperative adjuvant chemotherapy had 57.0%, 39.1% higher than the first phase Ⅱ, and injectable chemotherapy drugs after surgery to receive a complete of adjuvant chemotherapy is higher than the proportion of 61.2% oral type 38.8% chance of a relapse of patients with neurological surrounding violations is no violation of the patient''s peripheral nerve 2.60 times (OR: 2.60,95% CI = 1.22 ~ 5.52). There are opportunities for the integrity of chemotherapy in patients with chemotherapy relapse is less than 5.10 times the integrity of the patient (OR: 5.10,95% CI = 1.37 ~ 19.01). Relapse after patients received adjuvant chemotherapy integrity risk of death is no recurrence of 11.94 times (HR = 11.94,95% CI = 6.43 ~ 22.18) (P <0.001).
Conclusions and Recommendations
AJCC staging worse, the higher the risk of recurrence and death, relative, medical resources to spend more also to the survival and health care resource use case view, early detection, early detection is an important preventive policies. However, acceptance of the integrity of the chemical treatment the patient''s risk of recurrence and death are even higher than those who did not complete treatment, follow-up study of worth.
Keyword：Colorectal cancer, adjuvant chemotherapy, efficacy
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