대장직장암 위험 요인에 관한 환자 - 대조군의 연구

Abstract

[한글]

우리 나라에서 대장직장암은 그 발생률이 남녀 모두에서 4위를 차지하는 호발암이며 사망 원인 통계에서 살펴 볼 때 최근 10년 간 2배 정도로 사망률이 꾸준히 증가하고 있다.

그러나 우리 나라에서 어떠한 요인들이 대장직장암의 발생을 증가시키고 있는지 그 위험요인에 관련된 연구는 최근 발표된 1편의 논문에 그치고 있다. 따라서 본 연구는 한국인의 대장직장암 위험요인을 규명함으로써 우리나라에서 계속적으로 증가하고 있는 대장직장암의 예방사업에 기초자료를 제공하기 위해 시도된 환자-대조군 연구이다.

연구 대상자는 1998년 4월 8일부터 4월 30일까지 Y대학 부속 병원 외과 외래에서 수술 후 추후 관리를 받은 87명의 대장직장암 환자군과, 1998년 1월 4일부터 5월 8일까지 Y대학 부속 건강증진 센터에서 종합 검진을 받은 건강한 성인으로 환자군과 연령 및 성별이

짝짓기 된 87명의 대조군이었다.

연구 도구는 연구자가 문헌 고찰을 통하며 작성하고 간호학 교수 3인의 검토 ·수정을 거친 후 15명의 환자에게 사전 조사 후 완성하였다. 설문지의 내용은 대상자의 일반적 특성, 체질량 지수, 대장직장 관련 과거 질환력, 가족력, 여가 시 및 일과 시간의 육체적

활동량, 음주 및 흡연력, 식이력, 임신-출산력으로 구성되어 있다. 자료수집은 연구자 1인이 직접 하였으며 환자군의 경우 면접으로, 대조군의 경우 전화면접으로 하였다.

수집된 자료의 대조군 분포에 따라 각 요인을 범주화하고 로지스틱 회귀분석을 이용하여 대장직장암 발생에 관한 추정 교차비를 구하였으며 95% 신뢰구간을 구하여 통계적 유의도를 검증하였다. 그 결과는 다음과 같다

1. 일반적 특성으로서 학력은 대장직장암 발생과 유의한 관련이 없었으나 학력이 증가할수록 위험도가 감소하는 경향을 보였다. 월 평균수입은 100만원 이하인 군에 비해 250만원 이상인 군에서 교차비 0.21(0.08-0.54)로 유의하게 대장직장암발생 위험이 감소하였다.

2. 10년 전 비만은 유의한 대장직장암의 위험요인으로 BMI 21.00이하인 군에 비해 25.01이상인 군에서 교차비는 3.10(1.31-7.36)이었다.

3. 일과 시간의 육체적 활동량은 대장직장암과 유의한 관련이 업었으나 여가시간의 육체적 활동량과 월 평균 수입을 보장한 결과 육체적 중노동을 하는 그룹에서 대장직장암 발생 위험이 감소되었다. 여가 시간의 활동량은 유의하게 대장직장암 발생 위험을 감소시키는 요인으로서 운동을 전혀 하지 않는 군에 비해 일일평균 300kca1/d이하 흑은 그 이상의 열량을 소모하는 군에서 교차비가 각각0.21(0.10-0.46), 0.31(0.13--0.75)이었다.

4. 흡연은 대장직장암과 유의한 관련이 없는 것으로 나타났으나 흡연 지수가 증가함에 따라 대장직장암 발생의 위험도가 증가하는 경향을 보였다. 음주는 유의한 위험요인으로 음주 경험이 없는 군에 비해 있는 군에서 교차비는 1.83 (1.0-3.33)이었으며, 총 음주 기

간이 30년 이상인 경우 교차비는 5.87(1.72-19.99)로 증가하였다. 특히 주당 에탄을 섭취량이 400.01 g이상인 경우 교차비는 16.65 (3.85-71.99)로 과다한 음주가 대장직장암 발생 위험을 크게 증가시키는 것으로 나타났다.

5. 식이력은 대장직장암 발생과 유의한 관련이 있어서 기름기 많은 육류를 주2-3회 이상 섭취할 경우 교차비는 4.08(1.72-9.71)이었으며 생 야채 및 나물 등의 섭취빈도가 매일 2회 이상인 경우 교차비가 0.22(0.10-0.48)이었다.

6. 임신-출산력으로서 첫 임신 연령, 첫 분만 연령, 출산 횟수는 대장직장암 발생과 유의한 관련이 없는 것으로 나타났다.

7. 위의 결과에서 유의하게 나타난 요인을 단계적 선택법으로 다중 로지스틱회귀 분석한 결과 대장직장암 발생에 영향을 미치는 요인은 월 평균 수입, 10년 전 BMI, 여가 시간의 육체적 활동량, 주당 에탄올 섭취량, 기름진 육류 섭취 빈도, 그리고, 생 야채 및 나물의 섭취 빈도였으며 음주 경험 여부와 총 음주 기간은 제외되었다.

앞으로 본 연구 결과를 토대로 한국인의 대장직장암 위험 사정 도구를 개발 하여 이를 기초로 대장직장암 고위험군을 규명한다면 효과적인 대장직장암 예방 사업을 펼칠 수 있을 것이다. 또한 본 연구의 결과는 운동 프로그램이나 금주 프로그램 등 대장직장암 예방

을 위한 프로그램 개발에 지침이 될 수 있다.

A case-control study for risk factors of colorectal cancer

Im, Hyun Ah

Dept. of Nursing The Graduate School Yonsei University

This case-control study was conducted to investigate risk factors for colorectal

cancer the incidence of which is increasing in Korea.

The case sample comprised of all postoperative outpatient clients visiting the

general surgical department of a university medical center in Seoul after operation

between April 8, 1998 and April 30, 1998. There were 87 clients with histologically

confirmed cancer of the colon and rectum who were included in the sample. Controls

were selected from the Health Promotion Center of a university in Seoul who were

screened between January 4, 1998 and May 8, 1998. an matched by age group and sex.

The research tool was developed by the researcher based on a literature review,

consultation with nursing faculty, and a pilot study of 15 subjects. The

questionnaire covered the following; socioeconomic stales, height and weight,

history of colorectal related disease, family history, physical activity during

recreational and occupational hours, drinking and smoking history, dietary history,

parity related history.

All subjects were interviewed by the researcher; with face-to-face interviews for

the case sample and telephone interviews for the control sample. To estimated

odds ratios, subjects were categorized into 3 or 4 levels, using cut-points based

on the distribution of controls and odds ratios and 95% confidence interval(CI)

were obtained from logistic regression.

The following is summary of the results.

1. There was no statistically significant association between educational

background and risk of colorectal cancer, but decreased risk was observed as

educational level increase. Significant negative association was found for average

monthly income; OR 0.21(0.08-0.54) for subjects with an income of more than

2,500,000 won verses those with less than 1,500,000 won.

2. Body Mass Index(BMI) of 10 years ago was significant risk factor; OR

3.10(1.31-7.36) for more than 25.00 kg/m' versus less than or equal to 21.00kg/m'

3. There was no significant association between occupational Physical activity

and risk of colorectal cancer, but, after adjusting income and recreational

physical activity, risk was significantly decreased in the highly active group.

Significant negative association was observed in recreational physical activity; OR

for moderate active group(energy expenditure of lees than 300kcal/day) and highly

active group(greater than or equal to 300kca1/day) was 0.21 (0.10-0.46), 0.31

(0.13-0.75) relative to the inactive group.

4. There was no significant association with smoking history, but, risk tendency

was increased as smoking index increased. Alcohol drinking was a significant risk

factor; relative to non-drinker, OR 1.83(1.0-3.33) for ex-drinker, OR

5.87(1.72-19.99) for drinker of more than 30 years, OR 16.65(3.85-71.99) for

drinker of more thats 400.01g daily.

5. Animal fat showed a positive significant association with risk for colorectal

cancer; OR 4.08(1.72-9.71) for consumption of three times or more weekly. and

dietary filer was negatively associated; OR 0.22(0.10-0.48) for consumption of two

times or more daily.

6. There was no significant association between age at first pregnancy, age at

first birth, or parity and risk of colorectal cancer.

7. Multivariate logistic regression including significant variables using forward

stepwise selection method showed that all variables except drinking experience and

drinking duration were statistically significant.

These results will provide baseline data for the development of a cololectal

cancer risk appraisal tool for Koreans that will make prevention programs more

effective by identifying high risk group, and also aid in the development of

prevention programs for colorectal cancer such as exercise, alcohol-cessation

programs.

[영문]

This case-control study was conducted to investigate risk factors for colorectal cancer the incidence of which is increasing in Korea.

The case sample comprised of all postoperative outpatient clients visiting the general surgical department of a university medical center in Seoul after operation between April 8, 1998 and April 30, 1998. There were 87 clients with histologically confirmed cancer of the colon and rectum who were included in the sample. Controls were selected from the Health Promotion Center of a university in Seoul who were screened between January 4, 1998 and May 8, 1998. an matched by age group and sex.

The research tool was developed by the researcher based on a literature review, consultation with nursing faculty, and a pilot study of 15 subjects. The questionnaire covered the following; socioeconomic stales, height and weight, history of colorectal related disease, family history, physical activity during recreational and occupational hours, drinking and smoking history, dietary history, parity related history.

All subjects were interviewed by the researcher; with face-to-face interviews for the case sample and telephone interviews for the control sample. To estimated odds ratios, subjects were categorized into 3 or 4 levels, using cut-points based on the distribution of controls and odds ratios and 95% confidence interval(CI) were obtained from logistic regression.

The following is summary of the results.

1. There was no statistically significant association between educational background and risk of colorectal cancer, but decreased risk was observed as educational level increase. Significant negative association was found for average monthly income; OR 0.21(0.08-0.54) for subjects with an income of more than 2,500,000 won verses those with less than 1,500,000 won

2. Body Mass Index(BMI) of 10 years ago was significant risk factor; OR 3.10(1.31-7.36) for more than 25.00 kg/m' versus less than or equal to 21.00kg/m'

3. There was no significant association between occupational Physical activity and risk of colorectal cancer, but, after adjusting income and recreational physical activity, risk was significantly decreased in the highly active group.

Significant negative association was observed in recreational physical activity; OR for moderate active group(energy expenditure of lees than 300kcal/day) and highly active group(greater than or equal to 300kca1/day) was 0.21 (0.10-0.46), 0.31 (0.13-0.75) relative to the inactive group.

4. There was no significant association with smoking history, but, risk tendency was increased as smoking index increased. Alcohol drinking was a significant risk factor; relative to non-drinker, OR 1.83(1.0-3.33) for ex-drinker, OR 5.87(1.72-19.99) for drinker of more than 30 years, OR 16.65(3.85-71.99) for drinker of more thats 400.01g daily.

5. Animal fat showed a positive significant association with risk for colorectal cancer; OR 4.08(1.72-9.71) for consumption of three times or more weekly. and dietary filer was negatively associated; OR 0.22(0.10-0.48) for consumption of two times or more daily.

6. There was no significant association between age at first pregnancy, age at first birth, or parity and risk of colorectal cancer.

7. Multivariate logistic regression including significant variables using forward stepwise selection method showed that all variables except drinking experience and drinking duration were statistically significant.

These results will provide baseline data for the development of a cololectal cancer risk appraisal tool for Koreans that will make prevention programs more effective by identifying high risk group, and also aid in the development of prevention programs for colorectal cancer such as exercise, alcohol-cessation programs.