口腔癌篩檢效益評估-學術研究與國家政策實務的連結
口腔癌是國人常見的十大癌症之一，在我國男性常見癌症發生部位更高居第五位，且我國口腔癌的平均發生年齡為55歲左右，比全世界口腔癌平均發病年齡足足早了10年，我國口腔癌好發於青壯年男性，發病後對家庭乃至於整體社會的影響甚鉅；且早期的口腔癌的治療預後相當良好，不僅五年存活率可達到8成以上，治療後對生活品質的影響亦相對較小，因此對口腔癌的防治上，如何發現早期口腔癌個案則是我國衛生單位相當關注的重點。
何佩珊副教授、王文岑醫師及楊奕馨教授團隊研究利用現存的國家級資料庫- 癌症登記系統、口腔癌篩檢資料庫及全國死因登記檔等三個資料庫進行統整，並經由統計模式進行分析，得到以下結果:1. 若單純針對有無參與篩檢來進行比較，發現有參與篩檢及沒有參與篩檢的口腔癌個案的癌症分期並沒有太大差異；2. 若進一步依據篩檢結果分析發現，篩檢發現口腔癌前病變的個案，之後被確診為口腔癌時，其癌症分期有較高的比例是屬於早期的診斷；綜合以上結果，我們提出一個重要結論，要提升口腔癌的篩檢效益的重點除了要鼓勵口腔癌高危險群民眾進行篩檢外，篩檢時若能對口腔癌前病變病灶做比較準確地辨別，使得口罹患腔癌前病變的個案能有機會做進一步的追蹤確診，對於提升我國口腔癌篩檢政策的效益較有幫助。本研究結果發表後，亦將本研究的結論提供我國口腔癌篩檢政策面的回饋，強調口腔癌篩檢時發現口腔癌前病變的重要性，我國國民健康署亦因此特別在口腔強篩檢策略中，強調篩檢口腔癌前病變的重要性並擬訂提升篩檢口腔癌前病變的準確度的相關策略。
本篇研究論文-“Finding an oral potentially malignant disorder in screening program is related to early diagnosis of oral cavity cancer-Experience from real world evidence.”由何佩珊副教授、王文岑醫師及楊奕馨教授團隊發表，在2019年刊登於”Oral Oncology”，該期刊在牙科領域排名為前10%(2017年領域排名為3/91=3.3%)，在牙科專業領域上具相當權威性。本篇研究結合我國衛生福利部建置的癌症登記系統、口腔癌篩檢資料庫及全國死因登記檔等三個資料庫進行口腔癌篩檢效益的評估，並提供口腔癌篩檢政策規劃的參考。
Finding an oral
potentially malignant disorder in screening program is related to early
diagnosis of oral cavity cancer-Experience from real world evidence.
This paper is practiced by Dr. Pei-Shan Ho,
Dr. Wen-Chen Wang, and Dr. Yi-Hsin Yang, and published in
“Oral Oncology”, which is top
10% in (the ranking is 3/91=3.3% o f the Dentistry, Oral surgery and Medicine
in 2017 JCR).
The Objectives
of this study are to evaluate the effectiveness of the Taiwan
Oral Mucosal Screening (TOMS) program in stage-shift among oral cavity cancer
patients, and identifies the related factors with early cancer diagnosis. This
retrospective cohort study used the Taiwan Cancer Registry (TCR), TOMS and
Taiwan Death Registry (TDR) databases. We
identified oral cavity cancer patients (ICD-C-O: C00-C06) from the TCR during
2012–2015. Patients’ screening history, first screening status and subsequent
screenings were
analyzed with cancer stages and survival
outcomes.
The major results of this study is that the 5-year
survival rates for stages 0–4 were 83.9%, 82.1%, 72.7%, 60.1% and 38.0%. Among
18,625 patients identified from the TCR, 37% did not have any prior screenings.
Patients with prior positive or negativescreenings all had better survival
rates (3-year: 71.4% and 68.7% vs. 63.5%, Log-rank p-value < 0.0001).
Thebest chance for early-stage diagnosis occurs in oral potentially malignant
disorder (OPMD, OR=1.99, 95% CI=1.78–2.22, p < 0.0001) patients at their
first screenings. The hazard ratios (HR) for patients with prior screenings
indicated a significant survival benefit. The group of incomplete diagnosis
confirmation also has better survival (HR=0.78, 95% CI=0.81–0.93, p <
0.0001), and a greater chance of early diagnosis at
subsequent screenings. Some
important conclusions was found in this study.
While TOMS improved stage-shift for early cancer
diagnosis, we found no obvious differences in participants with cancers at
screening (stages 0–1: 26.3% vs. 27.8% in non-screening group). Survival
benefit and early diagnosis are found in most of screening groups, and
identifying an OPMD is particularly essential to early diagnosis of oral cavity
cancer patients.
Research
available at :https://pubmed.ncbi.nlm.nih.gov/30732947/
