目的：癌細胞於缺氧狀態下會誘導細胞內蛋白質產生變化，促使癌細胞適應缺氧狀態或遠離缺氧環境，進而使癌細胞侵襲周圍組織或產生轉移。然而，慢性肺疾病降低肺泡通透性，造成組織缺氧。本研究將以此為假說，探討臺灣地區攝護腺癌病人罹患慢性肺疾病是否會影響攝護腺癌之預後。
方法：本研究為回溯性世代研究，藉由1997 ~ 2009 年的2000 年百萬抽樣歸人檔進行2000 ~ 2007 年男性攝護腺癌之研究對象篩選，篩選後將其分為暴露組（有慢性肺疾病）以及非暴露組（無慢性肺疾病）。描述性統計使用卡方檢定以及雙樣本t檢定。存活分析使用Kaplan–Meier method 分析，以log-rank test 分析暴露組與非暴露組間是否具有統計學上顯著差異，最後以Cox proportional hazards regression 校正干擾因子。
結果：研究共篩選412 人，其中有172 人曾經有慢性肺疾病，240 人無慢性肺疾病。暴露組在年齡、共病症比例以及合併使用藥品上皆高於非暴露組。校正干擾因子後，發現慢性肺疾病不論在死亡 (adjusted hazard ratio [aHR] = 1.245, 95% confidence interval [CI] = 0.848 ~ 1.829) 或化學療法比例 (aHR = 0.545, 95% CI = 0.235 ~ 1.263) 的預後指標中，暴露組與非暴露組皆不達統計學上差異。
結論：攝護腺癌病人罹患慢性肺疾病與其死亡或化學療法比例的預後指標中皆不具相關性，但在死亡率上有增加之趨勢。未來需進一步使用其他類型之資料庫探討此議題，並克服樣本數不足的問題以提高內在效度。
Objective: Chronic pulmonary disease (CPD) leads to tissue hypoxia through decreased alveolar ventilation. Hypoxia-induced changes in the proteome promote tumor propagation by enabling cancer cells to adapt to nutritional or other stresses. The present retrospective study investigated a possible association between CPD and the prognosis of prostate cancer.
Methods: For this retrospective cohort study, data (period: 1997–2009) were obtained from the National Health Insurance Research Database 2000, Taiwan. Patients with prostate cancer (diagnosed between 2000 and 2007) were included in this analysis. The patients were grouped according to the presence (exposed group) or absence (unexposed group) of CPD. Differences between groups were assessed using the two sample t-test and chi-squared tests. Survival analysis was conducted using the Kaplan–Meier method, and differences between groups were analyzed using the log-rank test. Confounding factors were adjusted using Cox proportional hazards regression.
Results: A total of 412 patients with prostate cancer were included in this study (exposed group: 172 patients; unexposed group: 240 patients). The exposed group was characterized by higher age, comorbidity, and the use of drugs compared with the unexposed group. After adjustment, the presence of CPD was not associated with an increased risk for mortality (adjusted hazard ratio [aHR] = 1.25, 95% confidence interval [CI] = 0.848–1.829) and the use of chemotherapy (aHR = 0.55, 95% CI = 0.235–1.263).
Conclusions: The rates of all-cause mortality and the use of chemotherapy were not significantly different between the two groups. However, we noted an increasing trend in mortality. Additional studies with larger sample sizes are warranted to corroborate these findings.
