研究背景與目的: 結核病是全球性的感染病症，而肺癌在台灣前十大癌症死因中名列第三位，這兩種疾病之間的病理關聯是研究人員所亟欲了解的課題。因此本研究以台灣健保資料庫，針對肺結核病患研究其他共病症對罹患肺癌的風險影響，並且以混合的資料探勘和統計方法模型做研究分析。

研究方法: 搜尋2000至2002年間主要診斷為肺結核的新個案並持續追蹤至2011年。總共有6,172筆年齡大於20歲的新個案，並根據決策樹演算法的結果將族群分為中年族群 (1,459人) 和老年族群 (3,527人)，最後分別將兩個族群用association rule, Cox regression and survival analysis 作分析比較。

研究結果: 罹患肺結核的老年病患較罹患肺結核的中年病患有高出4倍的機率會罹患肺癌(8.45 versus 39.03 per 10,000 person-years)。罹患慢性阻塞性肺病(COPD) 分別在中年族群(6.64; 95% CI, 2.17-20.33)和老年族群(2.22; 95% CI, 1.52-3.23)都會提高罹患肺癌的風險。中年族群的肺結核病患通常相對於老年族群有較低的肺癌發生率(98.9% versus 95.8%, log-rank p < 0.0001)。

結論: 本研究發現在經過資料探勘方法並且依年齡分群研究後，不同年齡分層的肺結核病患之間的確有不一樣的肺癌病理模式。罹患癌症的風險會因為年齡的增長而逐漸提高。

Background and objective: Being as a global infectious disease and top 10 most fatal cancers in Taiwan, it is important to acquire the clinical pathology of tuberculosis (TB) and lung cancer. This study explored the association of tuberculosis and lung cancer with other comorbidities and investigated whether any featured attribute could be critical factor in influence of the risk of lung cancer among TB patients by conducting a hybrid data mining and statistical approach.
Methods: Study objects were be identified from the NHIRD with diagnosis of tuberculosis between 2000 and 2002 and tracked to 2011. In a cohort of 6,137 patients with tuberculosis and aged over 20 years old, 1,459 patients were divided into middle age group and 3,527 patients were identified as elder age group based on the result of decision tree. Association rule, Cox regression and survival analysis were used for comparison between groups.
Results: The incident rate of lung cancer is approximately 4-fold higher in the middle age group than the elder age group (8.45 versus 39.03 per 10,000 person-years). COPD increases the risk of lung cancer in both middle age group (6.64; 95% CI, 2.17-20.33) and elder age group (2.22; 95% CI, 1.52-3.23). The patients in middle age generally have more chance to be free from lung cancer compared to those with elder age in survival analysis (98.9% versus 95.8%, log-rank p < 0.0001).
Conclusions: This study provides a comprehensive analysis on impacts of age with comorbidities in risk of lung cancer among tuberculosis patients. The risk may increase further on patients in middle age group than those with elder age.

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Chapter 8.