乳癌預後之中醫舌診指標(2-1)

蔣依吾
國立中山大學
乳癌為我國女性好發癌症排名第一位，其死亡率也自民國86 年首次由女性癌症死因排名第5位躍升為第4 位，嚴重威脅女性健康。乳癌是發生在乳房組織上之惡性腫瘤，經由不正常分裂與繁殖所形成。由於乳癌是多發性，即便治癒，乳癌依舊有一定機率轉移，造成身體健康之損害，甚至危害生命。臨床治療發現，乳癌十年存活率平均達百分之六十，第一期乳癌治療後存活率達百分之八十，零期乳癌治療後存活率更接近百分之百。為了預知乳癌是否轉移，並早期治療病患以增加存活率，乳癌預後就相對重要。目前對於乳癌預後方式，計有六種因子：侵犯、遠端轉移、淋巴轉移、局部轉移病灶、炎性乳癌與腫瘤大小。並無統一指標，本為期兩年計畫旨在於運用科學化中醫舌診，觀察乳癌病患之舌象表現及舌頭特徵，進而推導乳癌預後之代表性舌診指標。
主持人於執行衛生署中醫藥委員會90至92年度之中醫舌診標準化整合研究計劃（CCMP90-RD-017, 90.06.01~ 90.12.31、CCMP91-RD-110, 91.01.01~ 91.12.31、 CCMP92-RD-102, 92.01.01~ 92.12.31、CCMP98-RD-031, 98.01.21~99.12.31、CCMP99-RD-105, 99.11.16~100.11.20）中，業已發展一可自動分析舌部影像特徵之中醫舌診電腦化系統，並經中醫藥委員會申請專利，於2008年4月獲准發明專利（"舌診系統及其方法"，中華民國專利證書發明第I296110號），復於98、99年推動中醫藥療效評估及診斷標準化類研究計畫(CCMP99-RD-037,99.11.18~100.11.20)中進行自動化舌診系統與中醫師診斷一致性研究，證實中醫舌診電腦化系統具高度自身一致性及符合舌診專家判讀之外部一致性，對中醫舌診電腦化系統而言，此為一重要研究成果，一旦系統之高度一致性獲得確認，未來研究方向將可由自動化舌診儀器之發展，進程至利用開發之舌診儀器，就特定疾病進行大規模或不同病情階段之取樣分析，推導具代表性之舌診指標；本為期兩年計畫為透過驗證之舌診儀器，針對特定疾病-乳癌，進行大規模舌診取樣之首度嘗試，期望能經由大量舌象特徵之統計分析，歸納乳癌預後之中醫舌診指標。
透過擷取舌象特徵具高度一致性之自動化舌診系統，可進一步依舌頭特徵，據以客觀評估乳癌病患於不同時期之舌象表現，並比較乳癌病患(實驗組)與正常人舌象(對照組)差異性，經由統計學之「特徵選取」(feature selection)方法，自各項舌頭特徵中，挑選對於乳癌預後之最佳部分特徵組合，分析歸納統計其特徵，期待透過中醫舌診系統推導非侵入式之乳癌預後指標，準確進行乳癌預評估，俾利提供臨床醫師之參考，進而分析與輔助治療乳癌病患，同時提高患者存活率與生活品質。
關鍵字：自動化舌診系統、乳癌。

The TCM indices of tongue diagnosis for the prognosis of breast cancer(2-1)

John Y. Chiang
National Sun Yat-Sen University
The occurrence rate and death rate of female breast cancer in Taiwan rank #2 in Asia, only second to Singapore. Breast canceris therefore a serious threat tofemalehealth.Breast cancer is amalignanttumorinthebreast tissue, caused by abnormalfissionand reproduction. Breast cancerismultiple. Even after breast canceris cured, there is remaininga certain probability ofmetastasis, posing threattothehealthorevenlife.After breast cancer is properly treated, survival rate is close to 100% in zero phase, 80% in the first phaseand 60% after being inflicted bybreast cancerfor over ten years. The prognosis of breast cancer is important to the prediction ofbreast cancermetastasis and early treatment ofpatients, which willlead to the increaseof survival rate. Traditionally, there aresixmajor indices for the prognosis of breast cancer, namely,encroachment, remote metastasis, lymphatic metastasis, local metastasis, inflammatorybreast cancer, andtumor size.Thistwo-yearprojecttargets onderiving the TCM indices for the prognosis of breast cancer by applying an Automatic Tongue Diagnosis System ATDS developed to extracttongue features.
The principal investigatorof this project hadled relevant projects (CCMP90-RD-017, 90.06.01~ 90.12.31, CCMP91-RD-110, 91.01.01~ 91.12.31, CCMP92-RD-102, 92.01.01~ 92.12.31, CCMP98-RD-031, 98.01.21~99.12.31, CCMP99-RD-105, 99.11.16~100.11.20),supported by the Committee on Chinese Medicine and Pharmacy (CCMP), DOH, from 2001 to 2003, aiming at the standardization of tongue diagnosis and successfully developed an automatic tongue diagnosis system. This research result was subsequently submitted for patent application by CCMP and was granted invention in April, 2008 ("Tongue diagnosis system and its method", ROC Patent: Invention No. I296110).The 99 year’s project(CCMP99-RD-037,99.11.18~100.11.20)aimed at deriving inter- and intra-agreement information for the ATDS developed. The results demonstrated that ATDS has far superior agreement performance over human counterparts. Based on these significant supporting data, the focus of future projects will be shifting from the development of ATDS to the applications of ATDS to clinical diagnosis, including large scale and temporal progression of specific diseases. This two-year project will employ the ATDSverified to extract the tongue features of patients with breast cancer. Through statistically analysis of the data collected and cross-referencing the existing indices of western medicine, we hope to derive meaningful TCM indices of tongue diagnosis for the prognosis of breast cancer. A TCM indices derived through the non-intrusive tongue diagnosis procedure can provide valuable information for clinical doctors to analyze the current status of a patient, dynamically schedule a treatment plan, and increase the patient’s survival rate and quality of life.
關鍵字：the prognosis of breast cancer, automatic tongue diagnosis system, TCM indices.