台灣的下咽癌和食道癌在世界上皆屬於高發生率，尤其男性的發生率遠超過 女性，而兩者大部分皆以鱗狀細胞癌為主。由自我廻歸年齡-年代-世代模型的分 析，兩者有相同年齡效應、年代效應及世代效應的趨勢，可推論下咽鱗狀細胞癌 和食道鱗狀細胞癌可能有相同機轉的致癌過程。另外，兩者皆以年齡效應最強，
世代效應次之，年代效應再次之。顯示兩者皆和菸、酒及檳榔等和生活習慣相關 的危險因子有很大的關係。由台灣獨特的檳榔文化及世代效應趨勢變化符合嚼食 檳榔時代背景變化，本研究推論檳榔的協同效應對下咽鱗狀細胞癌和食道鱗狀細 胞癌的高發生率扮演重要的角色。
下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌的發生率也是持續上升。西元 2003 年至 2007 年期間，下咽鱗狀細胞癌併發同時性和異時性第二原發食道鱗狀細 胞癌的發生率趨勢呈現相反的變化。其中，同時性第二原發食道鱗狀細胞癌的發 生率呈現較之前年代增加更快的趨勢，而異時性第二原發食道鱗狀細胞癌的發生 率則呈現下降的趨勢。顯示許多下咽鱗狀細胞癌的病人被診斷出第二原發食道鱗 狀細胞癌的時間提早。內視鏡系統的進步和臨床醫師的警覺性提高可能是造成這 樣趨勢變化的主要原因。
圖目錄：
Figure 1. 台灣男性下咽及食道鱗狀細胞癌年齡標準化發生率趨勢圖(年)
(上圖 y 軸: 發生率,下圖 y 軸: 發生率對數值)
Figure 2. 台灣男性下咽及食道鱗狀細胞癌年齡標準化發生率趨勢圖(年代組)
(上圖 y 軸: 發生率,下圖 y 軸: 發生率對數值)
Figure 3. 台灣女性下咽及食道鱗狀細胞癌年齡標準化發生率趨勢圖(年)
(上圖 y 軸: 發生率,下圖 y 軸: 發生率對數值)
Figure 4. 台灣女性下咽及食道鱗狀細胞癌年齡標準化發生率趨勢圖(年代組)
(上圖 y 軸: 發生率,下圖 y 軸: 發生率對數值)
Figure 5. 台灣男性下咽及食道鱗狀細胞癌發生率趨勢廻歸線分析
Figure 6. 男性下咽鱗狀細胞癌年齡-年代模型 (年齡為橫軸)
Figure 7. 男性食道鱗狀細胞癌年齡-年代模型 (年齡為橫軸)
Figure 8. 男性下咽鱗狀細胞癌年齡-年代模型 (年代為橫軸)
Figure 9. 男性食道鱗狀細胞癌年齡-年代模型 (年代為橫軸)
Figure 10. 男性下咽鱗狀細胞癌年齡-世代模型
Figure 11. 男性食道鱗狀細胞癌年齡-世代模型
Figure 12. 男性下咽及食道鱗狀細胞癌自我廻歸年齡-年代-世代模型
Figure 13. 男性下咽及中下食道鱗狀細胞癌自我廻歸年齡-年代-世代模型
Figure 14. 下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌個數年齡分佈圖，
1987-2007
Figure 15. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢
Figure 16. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢 (年代
組)
Figure 17. 男性下咽鱗狀細胞癌併發同時性第二原發食道鱗狀細胞癌發生率趨勢
Figure 18. 男性下咽鱗狀細胞癌併發同時性第二原發食道鱗狀細胞癌發生率趨勢
(年代組)
Figure 19. 男性下咽鱗狀細胞癌併發異時性第二原發食道鱗狀細胞癌發生率趨勢
Figure 20. 男性下咽鱗狀細胞癌併發異時性第二原發食道鱗狀細胞癌發生率趨勢
(年代組)
Figure 21. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>30
Figure 22. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>30 (年代組)
Figure 23. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>14
Figure 24. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>14 (年代組)
Figure 25. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>7
Figure 26. 男性下咽鱗狀細胞癌併發第二原發食道鱗狀細胞癌發生率趨勢，診斷差
異日>7 (年代組)
表目錄：
Table 1. 西元 1983-2007 年台灣下咽癌及食道癌組織學分佈情形
Hypopharyngeal neoplasm Esophageal neoplasm
men women all (%) men women all (%)
Hitological type
SCC* 7119 238 7357 (91.80) 17678 1395 19073 (82.88) Non-specified 256 14 270 (3.37) 1090 189 1279 (5.56) Others 359 28 387 (4.83) 2296 364 2660 (11.56)
Total 7734 280 8014 (100) 21064 1948 23012 (100)
Table 2. 下咽鱗狀細胞癌與食道鱗狀細胞癌年齡標準化發生率(年)
Year
Men Women
Esophageal SCC Hypopharyngeal SCC Esophageal SCC Hypopharyngeal SCC
1983 4.29 0.95 0.51 0.08
Table 3. 下咽鱗狀細胞癌與食道鱗狀細胞癌年齡標準化發生率(年代)
Period
Men Women
Esophageal SCC Hypopharyngeal SCC Esophageal SCC Hypopharyngeal SCC
1983-1987 4.12 1.04 0.46 0.06
1988-1992 4.34 1.54 0.5 0.08
1993-1997 5.74 2.34 0.54 0.07
1998-2002 7.73 3.29 0.64 0.12
2003-2007 10.14 4.46 0.66 0.13
(以每十萬人發生率表示)
Table 4. 下咽鱗狀細胞癌和食道鱗狀細胞癌診斷平均年齡及中位數年齡
Hypopharyngeal SCC Esophageal SCC
men women men women
Period mean age median age mean age median age mean age median age mean age median age 1983-1987 59.37 60.00 56.90 59.00 62.04 62.00 63.93 64.00 1988-1992 59.63 60.00 63.13 65.50 62.33 63.00 64.68 65.00 1993-1997 58.49 58.00 60.45 61.00 62.17 63.00 67.05 69.00 1998-2002 57.05 56.00 58.67 58.00 60.11 60.00 67.34 69.00 2003-2007 56.04 54.00 60.51 62.00 58.46 57.00 66.99 69.50 P for trend 0.0131* 0.0062* 0.7624 0.8968 0.0513 0.0994 0.0477* 0.0287*
Total 57.25 56.00 60.05 60.00 60.25 60.00 66.44 68.00
*statistically significant
Table 5. 男性下咽鱗狀細胞癌年齡-年代年齡標準化發生率
Age Period
1983-1987 1988-1992 1993-1997 1998-2002 2003-2007
30 0.02 0.04 0.26 0.36 0.63
35 0.23 0.38 0.95 1.74 2.93
40 0.95 1.14 2.11 4.51 6.99
45 2 2.64 4.17 6.89 10.35
50 2.62 4.3 7.64 9.35 14.07
55 2.98 6.05 9.38 12.76 14.08
60 4.34 6.4 9.46 12.39 16.39
65 5.79 5.47 8.13 12.1 14.72
70 4.67 8.63 8.59 10.11 15.77
75 4.13 7.27 8.5 8.3 11.33
80 3.7 3.38 9.03 11.35 10.36
85 4.9 4.14 3.9 10.35 7.97
(以每十萬人發生率表示)Table 6. 男性食道鱗狀細胞癌年齡-年代年齡標準化發生率
Age Period
1983-1987 1988-1992 1993-1997 1998-2002 2003-2007
30 0.14 0.06 0.08 0.46 0.72
35 0.33 0.61 1.27 2.68 4.13
40 1.3 2.25 3.74 7.78 13.2
45 2.96 4.57 7.45 12.72 20.7
50 8.52 10.15 12.5 18.81 27.09
55 14.86 13.52 20.06 26.93 33.68
60 21.43 18.81 25.4 33.09 41.39
65 22.66 24.73 26.6 34.05 41.03
70 25.66 26.61 31.26 32.94 38.46
75 28.63 28.55 35.12 33.87 35.47
80 16.67 14.37 28.73 34.45 34.73
85 9.79 17.59 22.12 29.85 35.06
(以每十萬人發生率表示)Table 7. 男性下咽鱗狀細胞癌年齡-世代年齡標準化發生率
Age Mid-cohort
1898 1903 1908 1913 1918 1923 1928 1933 1938 1943 1948 1953 1958 1963 1968 1973
30 0.02 0.04 0.26 0.36 0.63
35 0.23 0.38 0.95 1.74 2.93
40 0.95 1.14 2.11 4.51 6.99
45 2 2.64 4.17 6.89 10.35
50 2.62 4.3 7.64 9.35 14.07
55 2.98 6.05 9.38 12.76 14.08
60 4.34 6.4 9.46 12.39 16.39
65 5.79 5.47 8.13 12.1 14.72
70 4.67 8.63 8.59 10.11 15.77
75 4.13 7.27 8.5 8.3 11.33
80 3.7 3.38 9.03 11.35 10.36
85 4.9 4.14 3.9 10.35 7.97
(以每十萬人發生率表示)Table 8. 男性食道鱗狀細胞癌年齡-世代年齡標準化發生率
Age Mid-cohort
1898 1903 1908 1913 1918 1923 1928 1933 1938 1943 1948 1953 1958 1963 1968 1973 30 0.14 0.06 0.08 0.46 0.72 35 0.33 0.61 1.27 2.68 4.13
40 1.3 2.25 3.74 7.78 13.2
45 2.96 4.57 7.45 12.72 20.7
50 8.52 10.15 12.5 18.81 27.09 55 14.86 13.52 20.06 26.93 33.68
60 21.43 18.81 25.4 33.09 41.39 65 22.66 24.73 26.6 34.05 41.03
70 25.66 26.61 31.26 32.94 38.46 75 28.63 28.55 35.12 33.87 35.47
80 16.67 14.37 28.73 34.45 34.73 85 9.79 17.59 22.12 29.85 35.06
(以每十萬人發生率表示)
Table 9. 自我廻歸年齡-年代-世代模型係數對數表
Age effect E
sophageal SCCH
ypopharyngeal SCC30-34 -4.064 -3.162
Period effect E
sophageal SCCH
ypopharyngeal SCC1983-1987 -0.608 -0.898
1988-1992 -0.403 -0.396
1993-1997 0.009 0.093
1998-2002 0.377 0.459
2003-2007 0.626 0.743
Cohort effect E
sophageal SCCH
ypopharyngeal SCC1903 -8.584 -9.741
Table 10. 波以松廻歸分析和概似比檢定結果
APC 27 24.37 Reference Reference Esophageal SCC
Age 44 2655.46 2603.09 (17) <0.0001 Period 50 15437.12 15384.74 (23) <0.0001
Cohort 40 10577.18 10524.81 (13) <0.0001
AP 40 653.97 601.60 (13) <0.0001 AC 30 83.11 30.74 (3) <0.0001 PC 36 3263.33 3210.96 (9) <0.0001 APC 27 52.37 Reference Reference likelihood ratio statistics= increase in deviance from the APC model
df*= increase in df from the APC model
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