背景：儘管台灣30年來吸菸率大幅的下降，但台灣男性肺癌仍未有明顯的下降趨勢。本研究進行分析1995-2008年之間台灣男性肺癌病理組織型態之發生率與抽菸率之間的關係。
方法：本研究之年齡標準化發生率以世界衛生組織所公佈的2000年世界人口為計算基礎，以年齡-期間-世代模型進行分析，進行觀察年齡、期間與世代效果對肺癌趨勢的影響。
結果： 1970年代台灣男性吸菸率持續下降，經過30年後台灣男性肺癌仍維持高發生率趨勢。而與吸菸弱相關的腺癌發生率已大幅成長，完全取代鱗狀上皮細胞癌成為最常見的男性肺癌病理組織型態。從本研究的分析結果獲知，台灣抽菸率的下降，而男性肺癌高發生率趨勢，未來應加入抽菸之外的環境風險因子進行解釋台灣的男性肺癌趨勢。而空氣污染因子以懸浮粒子(PM₁₀)、二氧化硫(SO₂)、臭氧(O₃)普遍上有正相關性。
本研究之結果可作為台灣未來的肺癌預防重點，尤其對於肺癌防治現況而言，除了更嚴格的菸害防治政策外，仍極需納入其他的潛在風險因子進行肺癌預防控制，如控制石化工業廢氣、汽機車廢氣排放等產生懸浮粒子(PM₁₀)、二氧化硫(SO₂)、臭氧(O₃)空氣污染源的活動。

Background: Although radical shifts in smoking trends over the past few decades, male lung cancer remains a major cause of cancer deaths in many developed countries, and one of the most important public health issues. This study analyzed the recent trends in male lung cancer incidence rates with smoking prevalence in Taiwan (1995-2008) by histological subtypes.
Methods: Age-standardized incidence rates were computed using WHO (2000) standard population as reference, where age, period and cohort effects are analyzed by Poisson APC models to see how they affect the trend.
Results: Nevertheless smoking prevalence in Taiwan drops since 1976, the male lung cancer incidence rate still increase until 2004, and adenocarcinoma cancer has replaced squamous cell carcinoma as the most common lung cancer subtype. The results suggested that future cancer trends analysis could benefit from the model included potential air pollution factors as PM₁₀, SO₂, and O₃.
Contribution: Detail analyses show that the increased incidence cases may not fully explained by the previous studies arguing that Taiwan’s future lung cancer prevention focus should include not only tobacco control but also other possible risk factors as air pollution factors: PM₁₀, SO₂, and O₃.

論文審定書 i
誌　謝 ii
中文摘要 iii
英文摘要 iv
目　錄 vi
圖　次 viii
表　次 x
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 5
第二章 文獻探討 6
第一節 肺癌 6
國內外肺癌流行病學現況 6
肺癌的類型 6
小細胞癌(Small Cell Lung Cancer) 7
非小細胞癌簡介 7
第二節 年齡-期間-世代模型 15
第三章 研究方法 18
第一節 18
研究類型 18
研究基本單位 18
發生率與人口資料 19
癌症登記檔的資料品質 19
台灣成人吸菸率 20
第二節 統計方法 21
APC模型設定 21
第四章 研究結果與討論 23
第一節 年齡-期間-世代模型適配結果 23
世代效應 25
期間效應 27
第二節 空氣污染分析結果 27
空氣污染分析一：台灣整體空氣污染趨勢 28
台灣男性高肺癌標準化發生率之縣市 29
空氣污染縣市與肺癌發生率之關係 31
研究限制 36
第五章 結論與建議 37
參考文獻 39
附錄 49
第一節 縣市肺癌發生率發生率與空污趨勢 49
基隆市 49
宜蘭縣 50
台北縣 50
桃園縣 51
台中市 51
台中縣 52
彰化縣 52
雲林縣 53
嘉義縣 53
台南市 54
台南縣 54
第二節 年齡標準化發生率計算 55
第三節 APC模型分析 61
第四節 相關分析 64

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