東臺灣原住民之頭頸癌

Head and Neck Cancers of Aborigines in Eastern Taiwan

東台灣因先天地理隔閡、漢人進入較晚且開發較慢，目前超過四分之一的人口原住民，以阿美族為最大族群，其次為泰雅、布農、排灣等族。花蓮慈濟醫院為東台灣唯一之醫學中心，東台灣多數的頭頸癌病人是在此接受治療，故藉由分析慈濟醫院病人的資料，以深究原漢間是否有差別。收集1991年至2000年十年間，診斷為頭頸部鱗狀上皮細胞癌並於本院追蹤治療至少二年以上的病人進入本研究。依族群不同就其發生部位、性別比、年齡、臨床分期、存活時間等，加以回溯性分析比較。本研究追蹤至2002年12月止，平均追蹤時間為22.8個月。共計739名病人進入本研究，漢族564名，原住民175名，依人數多寡依序為阿美族100名、布農族37名、泰雅族20名、及其他族群18名。頭頸癌好發部位方面，阿美族的口腔癌與下咽癌病人人數相當，其他族群則是罹患鼻咽癌為主，不同於漢族病人以口腔癌最常見。發病年齡原住民多較漢族年老，尤其口腔癌差將近十歲（原住民發病年齡中位數為60.3歲，漢族為50.9歲）。男女比於漢族為8.0，原住民2.5，尤其在口腔癌與喉癌，原住民的男女比明顯較漢族低。原隹民在嗜用菸、酒、檳榔上，較漢族比率為多。臨床分期與五年存活率方面，原住民與漢族無顯著差異。雖然原住民嗜用菸、酒、檳榔的比率較漢族高，但頭頸癌的發病年齡卻較年老，且不同族裔間的好發部位也不同，推測可能是原漢病人間之基因差異、環境因子或彼此交互作用等造成影響。

Due to the geographic barrier and the late arrival of the Hall people, more than 25% of the population ill Eastern Taiwan is homogenous aborigines. Meanwhile the Tzu CM General Hospital is the only medical center ill the Eastern Taiwan, and treats most of the head and neck cancer patients from the region. The goal of this stud was to compare the clinical characteristics of head and neck cancers among different ethnic groups in Eastern Taiwan. Data from 739 patients were collected retrospectively. These head and neck cancer patients, with pathological proof, were diagnosed and treated ill Tzu Chi General Hospital from 1991 to 2000. Clinical data were compared between the Hall people and the aborigines. The mean follow-up period was 22.8 months. There were 564 Halls and 175 aborigines, the latter included 100 Amis, 37 Bunun, 20 Atayal, and 18 of other tribes. As for the most common cancer site, Amis had a equal incidence of oral cavity cancer and hypopharyngeal cancer other aborigines developed nasopharygneal cancer most frequently. However, oral cavity cancer was the leading cancer site ill Hall people. The median diagnostic age of aborigines was significantly older than Halls (60.3 vs. 50.9 yr.). The overall male/female ratio ill aborigines was significantly lower than Halls (2.5 vs. 8.0), especially ill the groups of oral cavity cancer and laryngeal cancer. Habitual use of betel nut and alcohol ill aborigines was also higher than Hans. Iii the studies of clinical stages and 5-year survival rates, Hans and aborigines showed 110 significant difference. The most frequent cancer sites vary ill different ethnic groups. The aborigines developed head and neck cancers at older age, even though they consumed more alcohol and betel nuts. The underlying genetic and/or environmental factors may both attribute to the differences of clinical presentation among these populations.