生育年齡中的女性患有子宮內膜異位症比例約 5% 至 10%，是一種比例相當高 的疾病。卵巢癌為婦科癌症排名第二位，卻為婦科癌症死亡之首。過去研究提到 子宮內膜異位症可能會轉變成癌症型態，在卵巢癌中亮細胞和類子宮內膜細胞與 子宮內膜異位症特別相關。本研究收集台灣健保資料庫中所有子宮內膜異位症患 者，以 Cox 比例風險模型及交叉驗證來找出子宮內膜異位症進展至卵巢癌中的危 險因子，並用來預測子宮內膜異位症病人得到卵巢癌的風險。
子宮頸癌中，鱗狀上皮細胞癌 (SCC, Squamous Cell Carcinoma) 約佔 85-90%， 其中鱗狀上皮細胞癌抗原 (SCC-Ag, Squamous Cell Carcinoma antigen)，是一種血 清腫瘤標記物。當患者排斥子宮頸抹片檢查時，可以使用腫瘤標記物 SCC-Ag 做 為子宮頸癌的篩檢的方法。本研究透過患者每次回診檢驗的 SCC-Ag 長期追蹤資 料，以 Cox 比例風險模型及交叉驗證比較不同型態的 SCC-Ag 對後續的預測能力， 並預測子宮頸癌病人復發及死亡的風險。

The proportion of women of childbearing age with endometriosis is approximately 5% to 10%, which is a relatively high proportion of diseases. Ovarian cancer ranks second in gynecological cancer, but it is the the highest mortality rate in gynecological cancer. Previous studies have mentioned that endometriosis may turn into a cancerous pat- tern in which clear cells and endometrioid carcinomas are particularly associated with endometriosis. This study collected all patients with endometriosis in the Taiwan Health Insurance Database and used the Cox proportional hazards model and cross-validation to identify risk factors for the progression of endometriosis to ovarian cancer and predict the risk of endometriosis patients get ovarian cancer.
In cervical cancer study, squamous cell carcinoma (SCC) accounts for approximately 85%-90% of patients, which squamous cell carcinoma antigen (SCC-Ag) is the relative tumor marker. When the patient rejects the Pap Smear Test, the tumor marker SCC-Ag can be used as a screening method for cervical cancer. In this study, the SCC-Ag longitudinal data are from each patient’s repeated visits to the hospital. We used the Cox proportional hazards model and cross-validation to compare the predictive power of different types of SCC-Ag and predict the risk of recurrence and death of cervical cancer patients.

論文審定書 i
論文公開授權書 ii
誌謝 iii
摘要 iv
Abstract v
1 動機與目的 1
1.1 子宮內膜異位症進展為卵巢癌的危險因子 1
1.2 子宮頸癌中SCC與存活的關係 1
2 資料描述 2
2.1 子宮內膜異位症資料 2
2.1.1 變數介紹 2
2.1.2 連續型變數 2
2.1.3 離散型變數 2
2.2 子宮頸癌資料 9
2.2.1 變數介紹 9
2.2.2 連續型變數 9
2.2.3 離散型變數 10
3 研究方法 13
3.1 Cox比例風險模型(Cox proportional hazard model) 13
3.1.1 Time independent cox proportional hazard model 13
3.1.2 Time dependent cox proportional hazard model 13
3.2 五摺交叉驗證(Five-Fold Cross-Validation) 14
3.3 一致性指標(Concordance index) 14
3.4 諾莫圖(Nomogram) 14
3.5 Lasagna plots 15
4 研究結果 15
4.1 子宮內膜異位症 15
4.2 子宮頸癌 21
4.2.1 子宮頸癌以復發為事件 21
4.2.2 子宮頸癌以死亡為事件 25
5 結論與結語 29
5.1 子宮內膜異位症 29
5.2 子宮頸癌 30
參考文獻 31

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