抽煙影響非小細胞肺癌的組織形態但是不能預測其預後：結果源於中山醫學大學附設醫院

目的：腺癌及鱗狀上皮癌是肺癌最重要的組織形態且與病人的吸煙史和性別的差異有關。本實驗的目的是研究台灣近年來的非小細胞肺癌(NSCLC)之組織形態流行病學上的差異。方法：收集西元1998至2006年間，315例在中山醫學大學附設醫院治療的非小細胞肺癌病人。使用羅吉斯回歸檢定(logistic regression)和Cox比例風險模型去檢定這些非小細胞肺癌病人的臨床因素與腫瘤組織形態特異性或預後的相關性。結果：經校正性別與其他臨床因素後，多變項羅吉斯回歸檢定發現不吸煙者得肺腺癌勝算比是吸煙者的10倍(p<0.05)，與病人的性別差異及其他檢定的臨床因素無關。Log rank檢定證實病人是男性，吸煙者，鱗狀上皮癌者或癌症晚期者，他們的存活時間較短。進一步使用Cox比例風險模型檢定，年齡與癌症分期是獨立的預後因子。結論：在台灣，吸煙史是影響肺癌組織形態最重要的因素，而不是性別。癌症分期仍是預測肺癌病人預後最強的因子。
Purpose: Tumor histology, characterized by adenocarcinoma (AD) or squamous cell carcinoma (SQ), has been related to differences in smoking history and gender. The aim of this epidemiological study was to investigate specificity of tumor histology and the effect of tobacco smoking in non-small cell lung cancer (NSCLC) patients in Taiwan. Methods: Data was collected for 315 NSCLC patients treated at Chung Shan Medical University Hospital between 1998 and 2006. Logistic regression testing and Cox proportional hazard model were used to identify the determinates for specific histology and for cancer death among NSCLC patients, respectively. Results: Among the factors affecting tumor histology of AD, the adjusted odds ratio for nonsmokers was almost 10 times as high as that for smokers (p<0.05), whereas the other factors, including age, gender and cancer stage, were not found to be significant. With regard to cancer death, multivariate Cox hazard models showed that cancer stage and age to be independent prognostic indicators. Conclusion: In Taiwan, smoking history was the major determinate of tumor histology of lung cancer but not gender. Cancer stage at diagnosis remains the most powerful indicator of prognosis in lung carcinoma.