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博碩士論文 etd-0812109-235750 詳細資訊
Title page for etd-0812109-235750
論文名稱
Title
射頻燒灼與酒精注射對極早期肝癌之成本效益分析
Cost-effectiveness Analysis between Percutaneous Radiofrequency Ablation and Ethanol Injection for Very Early Hepatocellular Carcinoma
系所名稱
Department
畢業學年期
Year, semester
語文別
Language
學位類別
Degree
頁數
Number of pages
92
研究生
Author
指導教授
Advisor
召集委員
Convenor
口試委員
Advisory Committee
口試日期
Date of Exam
2009-07-23
繳交日期
Date of Submission
2009-08-12
關鍵字
Keywords
成本效益、酒精注射、射頻燒灼、肝癌
cost-effectiveness, percutaneous ethanol injection, radiofrequency ablation, hepatocellular carcinoma
統計
Statistics
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中文摘要
一、背景:
目前有關射頻燒灼對於早期肝癌的文獻報告多以腫瘤大小3公分為分界,然而隨著高危險群病人接受篩檢的普及與影像學的進步,早期肝癌等於或小於2公分的病例逐漸增加,這類病患是否也需要使用射頻燒灼呢?其療效是否優於酒精注射?兩者之成本效益與風險評估如何?目前文獻報告並無法提供很完整的答案。本研究利用統計分析來評估兩者差異,以供面對抉擇時,醫療提供者、病患本人或家屬、甚或保險單位可以參考運用。
二、方法:
從南部某區域教學醫院之癌登資料內,收集自2002年1月1日至2008年4月30日止的肝癌病人,篩選出罹患單顆等於或小於2公分之極早期肝癌,且初始治療為接受射頻燒灼或酒精注射者為納入條件,以這兩組病人,進行回溯性的病例對照研究。先從人口學基本資料,包括性別、年齡、疾病復發之危險因子、預後影響因子等,進行比對,以確認兩組病人是否有統計學上之差異,再從復發率、存活率、併發症、醫療費用與住院天數等方面,評估比對兩組之成本效益與風險。
三、結果:
共有32位病患符合篩選條件:酒精注射組有22位:男13位,女9位,平均年齡63.73歲;射頻燒灼組有10位:男7位,女3位,平均年齡58.30歲。兩組的基本背景資料、危險及預後因子等方面並無統計上的顯著差異,但在住院天數(p=0.007)與治療費用(p<0.001)有統計上的顯著差異:完整治療一位極早期肝癌患者,酒精注射組平均花費新台幣16934.7元,射頻燒灼組平均花費新台幣51677.6元,兩組差為新台幣34732.9元。而兩組在併發症的發生率、治療後的總體肝癌復發率、復發時間與總體存活率方面,則無統計上的差異。
四、結論:
對於極早期肝癌而言,本研究之結論為,當其基本的背景資料、危險及預後因子等方面並無統計上的顯著差異時,射頻燒灼在醫療資源的使用與花費上明顯高於酒精注射,而併發症的發生率、治療後的總體肝癌復發率、復發時間與總體存活率方面,則與酒精注射無統計上的差異。
Abstract
Introduction: Most literatures researched radiofrequency ablation (RFA) for early hepatocellular carcinoma (HCC) defined the early tumor size as 3cm or less. However, detection rate of HCC smaller than 2 cm became increasing since high risk patients had received regular screening and the imaging techniques has been much improved. Whether RFA or percutaneous ethanol injection (PEI) is better for a patient with such a small HCC is still controversial.
Methods: We retrospectively obtained patients with single HCC 2 cm in diameter or smaller from the computerized medical records database in a local teaching hospital located at southern Taiwan, diagnosed during January 1, 2002 to April 30, 2008. Those patients received RFA (RFA group) or PEI (PEI group) as the first-line nonsurgical treatments were enrolled for further analysis. We compared baseline characteristics of RFA and PEI groups, including gender, age, possible risk factors of recurrence, and prognostic factors. Then, we analyzed recurrent rate, time to recurrence, survival rate, complication rate, mean cost of each treatment, and hospital stay of RFA and PEI groups.
Results: There were 32 patients qualified for the study design, including 22 in PEI group:13 males and 9 females with mean age was 63.73 years; and 10 in RFA group:7 males and 3 females with mea age was 58.30 years。No statistically significant differences between RFA and PEI groups were observed with respect to baseline characteristics. Nevertheless, there was significant difference between these two groups with respect to mean hospital stay (p=0.007) and mean cost (p<0.001): mean cost of PEI was NTD $16934.7; mean cost of RFA was NTD $51677.6, the difference was NTD $34732.9. There was no difference respect to complication rate, recurrent rate, time to recurrence and overall survival rate between RFA and PEI groups.
Conclusion: For patients with single HCC 2 cm in diameter or smaller (i.e. very early HCC), we concluded that: if under similar basic background, the cost of RFA was much higher than that of PEI, but no difference in the complication rate, recurrent rate, time to recurrence and overall survival rate between these two treatment.
目次 Table of Contents
第一章 緒論 1
第一節  研究背景與動機 1
第二節  研究問題與目的 3
第二章 文獻探討 5
第一節  肝癌之危險因子 5
第二節  早期肝癌之定義、篩檢及預後評估 7
第三節  早期肝癌之治療 11
第四節  射頻燒灼與酒精注射對早期肝癌之比較 14
第三章 研究方法 29
第一節 研究架構與流程 29
第二節 研究假設 30
第三節 研究對象 31
第四節 資料蒐集之方法 32
第五節 研究工具與統計分析方法 33
第四章 研究結果 35
第一節 基本背景資料與分析 35
第二節 醫療資源使用及併發症發生率分析 48
第三節 總體肝癌復發率與復發時間分析 52
第四節 總體存活率與存活曲線分析 56
第五章 研究討論 61
第一節 研究樣本背景資料之驗證 61
第二節 醫療資源使用及併發症發生率之探討 66
第三節 總體復發率與復發時間之探討 68
第四節 總體存活率之探討 69
第五節 本研究的限制 71
第六章 結論與建議 73
第一節 結論 73
第二節 建議與貢獻 74
參考文獻 75
參考文獻 References
References
American joint committee on cancer. Retrieved 2009/5/2, 2009, from http://www.cancerstaging.org/education/tnmschema/tnmschema.html#2
Arii, S., Yamaoka, Y., Futagawa, S., Inoue, K., Kobayashi, K., Kojiro, M., et al. (2000). Results of surgical and nonsurgical treatment for small-sized hepatocellular carcinomas: A retrospective and nationwide survey in japan. the liver cancer study group of japan. Hepatology (Baltimore, Md.), 32(6), 1224-1229.
Bosch, F. X., Ribes, J., Cleries, R., & Diaz, M. (2005). Epidemiology of hepatocellular carcinoma. Clinics in Liver Disease, 9(2), 191-211, v.
Bosch, F. X., Ribes, J., Diaz, M., & Cleries, R. (2004). Primary liver cancer: Worldwide incidence and trends. Gastroenterology, 127(5 Suppl 1), S5-S16.
Bruix, J. (1997). Treatment of hepatocellular carcinoma. Hepatology (Baltimore, Md.), 25(2), 259-262.
Bruix, J., Sherman, M., & Practice Guidelines Committee, American Association for the Study of Liver Diseases. (2005). Management of hepatocellular carcinoma. Hepatology (Baltimore, Md.), 42(5), 1208-1236.
Brunello, F., Veltri, A., Carucci, P., Pagano, E., Ciccone, G., Moretto, P., et al. (2008). Radiofrequency ablation versus ethanol injection for early hepatocellular carcinoma: A randomized controlled trial. Scandinavian Journal of Gastroenterology, 43(6), 727-735.
Castells, A., Bruix, J., Bru, C., Fuster, J., Vilana, R., Navasa, M., et al. (1993). Treatment of small hepatocellular carcinoma in cirrhotic patients: A cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology (Baltimore, Md.), 18(5), 1121-1126.
Child, C. G., & Turcotte, J. G. (1964). Surgery and portal hypertension : The liver and portal hypertension.
. Major Problems in Clinical Surgery, 1, 50-64.
Cho, Y. K., Kim, J. K., Kim, M. Y., Rhim, H., & Han, J. K. (2009). Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology (Baltimore, Md.), 49(2), 453-459.
CLIP. (1998). A new prognostic system for hepatocellular carcinoma: A retrospective study of 435 patients: The cancer of the liver italian program (CLIP) investigators. Hepatology (Baltimore, Md.), 28(3), 751-755.
Colombo, M. (2008). Natural history of hepatocellular carcinoma. Annali Italiani Di Chirurgia, 79(2), 91-97.
Daniele, B., & Perrone, F. (2005). Staging for liver cancer. Clinics in Liver Disease, 9(2), 213-23, vi.
de Baere, T., Risse, O., Kuoch, V., Dromain, C., Sengel, C., Smayra, T., et al. (2003). Adverse events during radiofrequency treatment of 582 hepatic tumors. AJR.American Journal of Roentgenology, 181(3), 695-700.
Di Bisceglie, A. M., Carithers, R. L.,Jr, & Gores, G. J. (1998). Hepatocellular carcinoma. Hepatology (Baltimore, Md.), 28(4), 1161-1165.
Di Stasi, M., Buscarini, L., Livraghi, T., Giorgio, A., Salmi, A., De Sio, I., et al. (1997). Percutaneous ethanol injection in the treatment of hepatocellular carcinoma. A multicenter survey of evaluation practices and complication rates. Scandinavian Journal of Gastroenterology, 32(11), 1168-1173.
Fattovich, G., Stroffolini, T., Zagni, I., & Donato, F. (2004). Hepatocellular carcinoma in cirrhosis: Incidence and risk factors. Gastroenterology, 127(5 Suppl 1), S35-50.
Goldberg, S. N., Gazelle, G. S., Halpern, E. F., Rittman, W. J., Mueller, P. R., & Rosenthal, D. I. (1996). Radiofrequency tissue ablation: Importance of local temperature along the electrode tip exposure in determining lesion shape and size. Academic Radiology, 3(3), 212-218.
Ikeda, M., Okada, S., Ueno, H., Okusaka, T., & Kuriyama, H. (2001). Radiofrequency ablation and percutaneous ethanol injection in patients with small hepatocellular carcinoma: A comparative study. Japanese Journal of Clinical Oncology, 31(7), 322-326.
Izumi, R., Shimizu, K., Ii, T., Yagi, M., Matsui, O., Nonomura, A., et al. (1994). Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology, 106(3), 720-727.
Koda, M., Murawaki, Y., Mitsuda, A., Ohyama, K., Horie, Y., Suou, T., et al. (2000). Predictive factors for intrahepatic recurrence after percutaneous ethanol injection therapy for small hepatocellular carcinoma. Cancer, 88(3), 529-537.
Lang, H. C., Wu, J. C., Yen, S. H., Lan, C. F., & Wu, S. L. (2008). The lifetime cost of hepatocellular carcinoma : A claims data analysis from a medical centre in taiwan. Applied Health Economics and Health Policy, 6(1), 55-65.
Lang, K., Danchenko, N., Gondek, K., Shah, S., & Thompson, D. (2009). The burden of illness associated with hepatocellular carcinoma in the united states. Journal of Hepatology, 50(1), 89-99.
Lee, H. S., Han, C. J., & Kim, C. Y. (1993). Predominant etiologic association of hepatitis C virus with hepatocellular carcinoma compared with hepatitis B virus in elderly patients in a hepatitis B-endemic area. Cancer, 72(9), 2564-2567.
Lencioni, R., & Crocetti, L. (2005). A critical appraisal of the literature on local ablative therapies for hepatocellular carcinoma. Clinics in Liver Disease, 9(2), 301-14, viii.
Lencioni, R. A., Allgaier, H. P., Cioni, D., Olschewski, M., Deibert, P., Crocetti, L., et al. (2003). Small hepatocellular carcinoma in cirrhosis: Randomized comparison of radio-frequency thermal ablation versus percutaneous ethanol injection. Radiology, 228(1), 235-240.
Lin, S. M., Lin, C. J., Lin, C. C., Hsu, C. W., & Chen, Y. C. (2005). Randomised controlled trial comparing percutaneous radiofrequency thermal ablation, percutaneous ethanol injection, and percutaneous acetic acid injection to treat hepatocellular carcinoma of 3 cm or less. Gut, 54(8), 1151-1156.
Livraghi, T., Goldberg, S. N., Lazzaroni, S., Meloni, F., Solbiati, L., & Gazelle, G. S. (1999). Small hepatocellular carcinoma: Treatment with radio-frequency ablation versus ethanol injection. Radiology, 210(3), 655-661.
Livraghi, T., Meloni, F., Di Stasi, M., Rolle, E., Solbiati, L., Tinelli, C., et al. (2008). Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: Is resection still the treatment of choice? Hepatology (Baltimore, Md.), 47(1), 82-89.
Livraghi, T., Salmi, A., Bolondi, L., Marin, G., Arienti, V., Monti, F., et al. (1988). Small hepatocellular carcinoma: Percutaneous alcohol injection--results in 23 patients. Radiology, 168(2), 313-317.
Livraghi, T., Solbiati, L., Meloni, M. F., Gazelle, G. S., Halpern, E. F., & Goldberg, S. N. (2003). Treatment of focal liver tumors with percutaneous radio-frequency ablation: Complications encountered in a multicenter study. Radiology, 226(2), 441-451.
Llovet, J. M., Fuster, J., & Bruix, J. (1999). Intention-to-treat analysis of surgical treatment for early hepatocellular carcinoma: Resection versus transplantation. Hepatology (Baltimore, Md.), 30(6), 1434-1440.
Marrero, J. A. (2005). Screening tests for hepatocellular carcinoma. Clinics in Liver Disease, 9(2), 235-51, vi.
Okuda, K., Ohtsuki, T., Obata, H., Tomimatsu, M., Okazaki, N., Hasegawa, H., et al. (1985). Natural history of hepatocellular carcinoma and prognosis in relation to treatment. study of 850 patients. Cancer, 56(4), 918-928.
Pugh, R. N., Murray-Lyon, I. M., Dawson, J. L., Pietroni, M. C., & Williams, R. (1973). Transection of the oesophagus for bleeding oesophageal varices. The British Journal of Surgery, 60(8), 646-649.
Ruzzenente, A., Manzoni, G. D., Molfetta, M., Pachera, S., Genco, B., Donataccio, M., et al. (2004). Rapid progression of hepatocellular carcinoma after radiofrequency ablation. World Journal of Gastroenterology : WJG, 10(8), 1137-1140.
Shiina, S., Teratani, T., Obi, S., Sato, S., Tateishi, R., Fujishima, T., et al. (2005). A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology, 129(1), 122-130.
Sutherland, L. M., Williams, J. A., Padbury, R. T., Gotley, D. C., Stokes, B., & Maddern, G. J. (2006). Radiofrequency ablation of liver tumors: A systematic review. Archives of Surgery (Chicago, Ill.: 1960), 141(2), 181-190.
Wang, L. Y., You, S. L., Lu, S. N., Ho, H. C., Wu, M. H., Sun, C. A., et al. (2003). Risk of hepatocellular carcinoma and habits of alcohol drinking, betel quid chewing and cigarette smoking: A cohort of 2416 HBsAg-seropositive and 9421 HBsAg-seronegative male residents in taiwan. Cancer Causes & Control : CCC, 14(3), 241-250.
Yarbro, J. W., Page, D. L., Fielding, L. P., Partridge, E. E., & Murphy, G. P. (1999). American joint committee on cancer prognostic factors consensus conference. Cancer, 86(11), 2436-2446.
中央健康保險局-民眾服務-快捷查詢. Retrieved 2009/5/2, 2009, from http://www.nhi.gov.tw/inquire/query2.asp?menu=1&menu_id=8&WD_ID=94
我國生命表-內政部統計處網站. Retrieved 2009/4/15, 2009, from http://www.moi.gov.tw/stat/life.aspx
統計公布欄-行政院衛生署. Retrieved 2009/4/15, 2009, from http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=10327&class_no=440&level_no=4
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