I,II-2,III

Grade A Grade B Grade C Level I Level II-2,III Level III Level III-IV Class A and Level
Class B Class C 無
I,II-2,III
0 1 1 0 8 2 1 1 2 1 1
1.指標類型：治療前（1）
2.指標名稱：大腸直腸癌病人手術前在病歷上有至少接受包括「胸部x光」及「腹部超音波或CT scan或MRI」的百分比。

3.指標定義：分子：大腸直腸癌病人手術前在病歷上有臨床分期的紀錄者證明至少接受包括「胸部x光」及「腹部超音波或CT scan
或MRI」的病人數（相關檢查不限於本院，外院檢查亦可）。

分母：大腸直腸癌病人數。

4.指標選取理由：看治療前檢查的完整性。

5.指標資料來源：台灣癌症中心資料庫與實地訪查。

6.參考文獻：RCSI 2002
7.實證強度/ 推薦等級（出處）: Grade C (RCSI 2002)
8.備註：RCSI-All patients, particularly those with rectal cancer,should have pre-operative staging to determine the local extent of the disease
and the presence of lung and liver metastases.
9.修訂：原指標敘述為「大腸直腸癌病人手術前在病歷上有臨床分期的紀錄者證明至少接受包括胸部x光及超音波或CT scan的百分比
1
1.指標類型：治療（1）
2.指標名稱：接受大腸直腸癌切除術之病人，至少於術前6個月或術後6個月內，於病歷上記載曾接受全大腸檢查（大腸鏡檢或直腸
鏡檢加加下消化道鋇劑攝影）。

3.指標定義：分子：接受大腸直腸癌切除術之病人，至少於術前6個月或術後6個月內，在病歷上記載曾接受全大腸檢查（大腸鏡檢
或直腸鏡檢加加下消化道鋇劑攝影）之人數。

（相關檢查不限於本院，外院檢查亦可）
分母：接受大腸直腸癌切除術之病人數。

4.指標選取理由：多發癌症。

5.指標資料來源：台灣癌症中心資料庫與健保申報檔
6.參考文獻：RAND 2000；Isler 1987
7.實證強度/ 推薦等級（出處）:Level II-2, III(RAND 2000)
8.備註：RAND -Patients who have undergone surgical resection for colon or rectal cancer should have documentation in the chart that
colonoscopy or barium enema with sigmoidoscopy was offered within the preceding 12 months.
Isler -Colonoscopy prior to surgery for colorectal carcinoma is highly desirable and may potentially improve long term survival.
9.修訂：術後放寬到6個月內
1.指標類型：治療（2）
2.指標名稱：malignant polyp若有下列A.B.C.D.之一，於病理報告後6週內接受廣泛性切除術（wide surgical resection）之百分比。

A.大腸鏡檢報告指出息肉未完全被切除
B.手術切除外緣之癌細胞呈陽性
C.癌細胞已侵犯淋巴或靜脈組織
D.病理顯示為笫3級或屬
分化不全之癌細胞
3.指標定義：分子： malignant polyp病人，病理報告有下列A.B.C.D.之一記錄之病人，於病理報告後6週內接受廣泛性切除術（wide
surgical resection）之病人數。

分母：malignant polyp病人，病理報告有下列A.B.C.D.之一記錄之病人數
4.指標選取理由：提升治癒率
5.指標資料來源：實地訪查Stage 1病人病歷。

6.參考文獻：RAND 2000
7.實證強度/ 推薦等級（出處）:Level II-2, III(RAND 2000)
8.備註：RAND -Patients diagnosed with a malignant polyp should be offered a wide surgical resection within 6 weeks if any of the following
are true: a. the colonoscopy report states that the polyp was not completely excised; b. the margins are positive; c. lymphatic or venous invasion is present; d. histology is grade 3 or poorly differentiated.
2
1.指標類型：治療（3）
2.指標名稱：被診斷為大腸癌病理期別1-3期且尚未轉移的病人，必須在病理診斷後六個禮拜內(至該醫院就醫之日起算)提供治癒性切除（curative resection）。

3.指標定義：
3(a) 指標定義：
分子：確定病理診斷為第一期到第三期大腸癌病人，在診斷後六個禮拜內（到該醫院的日期來計算）提供根除性切除（curative resection）的病人數。

分母：確定診斷為病理診斷為第一期到第三期大腸癌病人數(排除轉院的病人)。

(診斷的定義:切片得到病理報告那天，如果沒有辦法得到tissue proof的話，就要看臨床和image檢查有conclusion的那天算起。

)
3(b) 指標定義：
分子：確定病理診斷為第一期到第三期大腸癌病人，在診斷後六個禮拜內（到該醫院的日期來計算）提供根除性切除（curative resection）的病人數。

分母：確定診斷為病理診斷為第一期到第三期大腸癌病人數(納入轉院的病人)。

(診斷的定義:切片得到病理報告那天，如果沒有辦法得到tissue proof的話，就要看臨床和image檢查有conclusion的那天算起。

)
4.指標選取理由：改善病人存活情形
5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000
7.實證強度/ 推薦等級（出處）: Level II-2, III(RAND 2000；Nogueras JJ.1993)
8.備註：RAND -Patients who are diagnosed with colon cancer and do not have metastatic disease1 should be offered a wide resection with
anastamosis2 within 6 weeks of diagnosis.
Nogueras JJ.-In the absence of curative medical therapy, surgical resection remains the cornerstone of treatment for patients with colorectal carcinoma.
1.指標類型：治療（4）
2.指標名稱：大腸直腸癌1～3期有手術病人，在組織病理報告中載明手術邊界及淋巴結侵犯情形（包括手術邊界、淋巴結數、淋巴
結被侵犯數）之比例。

3.指標定義：分子：大腸直腸癌1～3期有治癒性切除（curative resection）手術病人，在組織病理報告中載明手術邊界及淋巴結侵犯
3
情形（包括手術邊界、淋巴結數、淋巴結被侵犯數）之人數。

分母：大腸直腸癌1～3期有手術病人數。

排除只作polypectomy的病人
4.指標選取理由：後續的治療需要靠病理期別來判別，且影響復發情形。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：NHS 2003, SIGN 2003
7.實證強度/ 推薦等級（出處）:Class B（SIGN 2003）
8.備註：NHS -The proportion of histopathology reports which give the degree of involvement of surgical margins, including circumferential
margins, the number of lymph nodes examined and the number involved.
SIGN - Pathological reporting of colorectal cancer resection specimens should include information on:Tumour differentiation, Staging (Dukes' and tumour, node, metastasis [TNM] systems), Margins (peritoneal and circumferential resection margin [CRM]), Extramural vascular invasion.
1.指標類型：治療（5）
2.指標名稱：病理期別第1-3期大腸直腸癌病人，手術邊界為陰性之百分比。

3.指標定義：分子：病理期別第1-3期大腸直腸癌病人，手術邊界為陰性之病人數。

分母：有申報手術邊界的1-3期大腸直腸癌病人數。

排除病理報告未提及手術邊界之病例
4.指標選取理由：保證手術邊緣乾淨。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000；Nogueras JJ. 1993.
7.實證強度/ 推薦等級（出處）:Level II-2, III（RAND 2000）
8.備註：RAND -Patients who undergo a wide surgical resection should have “negative margins” noted on the most recent final pathology report or have documentation that they were offered a repeat resection if they meet either of the following criteria: a. Stage I colon cancer; b. Stage II or III colon cancer4 that is not invading into other organs (not a T4 lesion5).
Nogueras JJ.-There are certain technical factors under the control of the surgeon that may have prognostic significance for the patient. These include the length of the distal margin of resection, the use of intraluminal cytotoxic solutions to reduce the viability of exfoliated cancer cells, and the technique of colon anastomosis.
4
1.指標類型：治療（6）
2.指標名稱：大腸直腸癌病人接受手術後，病理報告至少呈現T、N期別之百分比。

3.指標定義：分子：大腸直腸癌病人接受手術後，病理報告至少呈現T、N期別人數。

分母：大腸直腸癌病人接受手術人數。

4.指標選取理由：決定後續治療方法，追蹤治癒之用。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：SSAT 2000, SIGN 2003
7.實證強度/ 推薦等級（出處）:Class B（SIGN 2003）
8.備註：SSAT -The clinicopathologic stage of disease is the most important determinant of survival after surgical resection.
SIGN- Pathological reporting of colorectal cancer resection specimens should include information on:Tumour differentiation, Staging (Dukes' and tumour, node, metastasis [TNM] systems), Margins (peritoneal and circumferential resection margin [CRM]), Extramural vascular invasion.
1.指標類型：治療（7）
2.指標名稱：病理期別第1-3期大腸直腸癌手術病人，淋巴結病理檢查12顆以上百分比。

3.指標定義：分子：第1-3期大腸直腸癌手術病人，淋巴結病理檢查12顆以上病人數。

分母：第1-3期大腸直腸癌手術病人。

（排除Polyp或wide excision或術前有放射線治療之病人。

）
4.指標選取理由：檢查的完整性。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：AJCC 2002
7.實證強度/ 推薦等級（出處）: 專家意見（Level 3 or 4）
8.備註：
5
1.指標類型：治療（8）
2.指標名稱：病理報告是否有依據CAP（College of American pathology）或類似的check list做check。

3.指標定義：分子：大腸直腸癌病人，病理報告有依據CAP（College of American pathology）或類似的check list做check之病人數。

分母：大腸直腸癌病人數。

4.指標選取理由：病理報告的完整性。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：NHS 2003、CoC 2004.
7.實證強度/ 推薦等級（出處）:
8.備註：NHS -Use of suitably detailed pro-forma for histopathology data; this should be based on the ACPGBI national colorectal cancer data
set, to which all teams should contribute.
1.指標類型：治療（9）
2.指標名稱：大腸癌病理期別第三期病人，術後6週內接受化學治療之百分比。

3.指標定義：分子：病理期別大腸癌第三期病人，手術後6週接受化學治療之人數。

分母：病理期別大腸癌第三期有手術病人。

(診斷、手術與化療皆為同一醫院，排除未接受化療之病人)
4.指標選取理由：增加病人存活率
5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000, Moertel 1994；Guidelines 2001
7.實證強度/ 推薦等級（出處）: Level I, II-2, III(RAND 2000; Moertel 1994)；Class A（Guidelines 2001）
8.備註：RAND- Patients with Stage III colon cancer who have undergone a surgical resection should be offered adjuvant chemotherapy6
within 6 weeks of surgery and not before 21 days after surgery with a published 5-FU-containing regimen.
Moertel -The anticipated use of postoperative adjuvant therapy that is known to be effective should lead to major reductions in national mortality from these common cancers.
Guidelines -Patients with Dukes C colon cancer should be considered for adjuvant chemotherapy.
6
1.指標類型：治療（10）
2.指標名稱：第二、三期（臨床期別為主）直腸癌病人，6週內開始治療（手術或放療或CCRT）的百分比。

3.指標定義：分子：第二、三期直腸癌病人，6週內開始治療（手術或放療或CCRT）的人數。

分母：第二、三期（臨床期別為主）直腸癌病人數。

限制:診斷與治療同一醫院病人
4.指標選取理由：避免病人治療延後。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000；SSAT 2000
7.實證強度/ 推薦等級（出處）:Level II-2, III (RAND 2000)
8.備註：RAND -Patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, should be offered one of the
following surgical resections within 6 weeks of diagnosis:1.l ow anterior resection;2.a bdominal perineal resection.
SSAT -For stage II (invasion into the muscularis propria of the rectal wall) or stage III rectal cancer (metastases to regional lymph nodes), radiation therapy is a useful preoperative or postoperative adjunct and is also used in combination with chemotherapy.
1.指標類型：治療（11）
2.指標名稱：由第二、三期直接做化療及放療(CCRT)直腸癌病人，CCRT算起，16週內開完刀的百分比。

3.指標定義：分子：第二、三期直接做化療及放療(CCRT)直腸癌病人，CCRT算起，16週內開完刀的病人數。

分母：第二、三期直腸癌病人，直接做化療及放療CCRT直腸癌病人數。

4.指標選取理由：提供治癒的機會
5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000；Nogueras JJ.
7.實證強度/ 推薦等級（出處）:Level II-2, III（RAND 2000）
8.備註：RAND -Patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, should be offered one of the
following surgical resections within 6 weeks of diagnosis:1.l ow anterior resection;2.a bdominal perineal resection. Nogueras JJ.-In the absence of curative medical therapy, surgical resection remains the cornerstone of treatment for patients with colorectal carcinoma. Curative resections should include removal of the lymphatic drainage of the tumor-bearing segment of colon. When there is adjacent organ invasion by the colonic primary, en block resection of the entire tumor mass with adequate margins is the procedure of choice.
7
1.指標類型：追蹤（1）
2.指標名稱：第一、二、三期大腸直腸癌病患，在完成所有治療後，在六個月內接受醫師檢查之比率。

3.指標定義：分子：第一、二、三期大腸直腸癌病患，在完成所有治療後，在六個月內接受醫師檢查之人數。

分母：第一、二、三期大腸直腸癌病人數
4.指標選取理由：減少死亡率。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000；Desch CE 2000.
7.實證強度/ 推薦等級（出處）:Level II-2, III (RAND 2000)；Class V./ Panel Consensus.（Desch CE 2000）
8.備註：RAND- Patients with Stages I, II, and III colorectal cancer should receive a visit with a physician for a history and physical where
colorectal cancer is addressed in the assessment and plan at least every 6 months for 3 years after initial treatment.
Desch CE,2000 -There are no data that directly address the contribution of the history and physical examination to outcomes of colorectal cancer surveillance. However, it is the consensus of the expert panel to suggest that a clinical history and pertinent physical examination should be performed every 3 to 6 months for the first 3 years and annually thereafter.
1.指標類型：追蹤（2）
2.指標名稱：第I, II,與III期大腸直腸癌病人,至少在手術後2年內與及其後每3年，接受一次大腸鏡檢或雙對比鋇劑照影之比率。

3.指標定義：分子：第I, II,與III期大腸直腸癌病人,至少在手術後2年內與及其後每3年，接受一次大腸鏡檢或雙對比鋇劑照影之
人數。

分母：第I, II,與III期大腸直腸癌病人數。

4.指標選取理由：減少局部復發。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000
7.實證強度/ 推薦等級（出處）:Level II-2, III (RAND 2000)
8.備註：RAND - Patients with Stages I, II, and III colorectal cancer should receive colonoscopy or double contrast barium enema three years
after surgery and every five years thereafter.
8
1.指標類型：追蹤（3）
2.指標名稱：只經過polypectomy 治療之惡性息肉病人，在polypectomy治療後12個月內接受大腸鏡檢查之比率。

3.指標定義：分子：只經過polypectomy 治療之惡性息肉病人，在polypectomy治療後12個月內，大腸鏡檢查之病人數。

分母：只經過polypectomy 治療之惡性息肉病人數。

4.指標選取理由：減少局部復發。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RAND 2000；Polyp Guideline 1993
7.實證強度/ 推薦等級（出處）:Level III （RAND 2000）
8.備註：RAND -Patients with a malignant polyp treated with polypectomy alone should be offered colonoscopy within 6 months of the
polypectomy.
Polyp Guideline –A.Postpolypectomy Surveillance.B. Repeated colonoscopy to check for missed synchronous and for metachronous adenomas is performed in 3 years for most patients with a single, or only a few adenomas, provided they have had a high-quality initial clearing examination.C. Selected patients with multiple adenomas or those who have had a suboptimal clearing examination might require colonoscopy at 1 and 4 years.D. After one negative 3-year follow-up examination, subsequent surveillance intervals may be increased to 5 years.
1.指標類型：追蹤（4）
2.指標名稱：各期別（1～4期）五年整體存活率
3.指標定義：分子：各期別（1～4期）大腸直腸癌五年整體存活人數。

分母：各期別（1～4期）大腸直腸癌病人數。

4.指標選取理由：評估各期別大腸直腸癌整體品質，及建立各期別整體存活率資料。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：Guidelines 2001
7.實證強度/ 推薦等級（出處）:Class C（Guidelines 2001）
8.備註：Guidelines -Follow-up is necessary for audit, which should be structured to determine post-operative mortality,
anastomotic leak rates, colostomy rates and 5-year survival. This should be regarded as a routine part of a Cancer Unit＇s work.
9
1.指標類型：追蹤（5）
2.指標名稱：各期別（1～3期）直腸癌五年局部復發率
3.指標定義：分子：各期別（1～3期）直腸癌五年局部復發人數。

分母：各期別（1～3期）直腸癌病人數。

4.指標選取理由：評估各期別直腸癌整體品質，及建立各期別整體存活率資料。

5.指標資料來源：台灣癌症中心資料庫
6.參考文獻：RCSI 2002
7.實證強度/ 推薦等級（出處）:Grade B（RCSI 2002）
8.備註：RCSI 2002-Local recurrence rates after curative resection for rectal cancers in the region of 10% or even lower within 2 years of
operation.
參考文獻：
AJCC 2002: Frederick L. Greene, David L. Page, Irvin D. Fleming...etal.. AJCC Cancer Staging Manual (6th Edition), page 114
BMJ2003：Paris P Tekkis, Jan D Poloniecki, Michael R Thompson...etal. Operative mortality in colorectal cancer: prospective national study.
BMJ. 2003 November 22; 327 (7425): 1196–1201
CoC 2004：Cancer Program Standard 2004 .Commission on Cancer.
Desch CE 2000：Desch CE, Benson AB 3rd, Smith TJ, Flynn PJ, Krause C, Loprinzi CL, Minsky BD, Petrelli NJ, Pfister DG, Somerfield MR.
Recommended colorectal cancer surveillance guidelines by the American Society of Clinical Oncology. J Clin Oncol 1999
Apr;17(4):1312-21. [9 references]
Guidelines 2001：Guidelines for the management of Colorectal Cancer,2001.Issued by The Association of Coloproctology of Great Britation and Ireland.
Isler 1987：Isler et al., 1987 Disease of the Colon and Rectum 1987,30(6),435-439
Moertel 1994：Moertel, Charles G. Drug Therapy: Chemotherapy For Colorectal Cancer. N Engl J Med V olume 330(16) 21 Apr 1994 pp 1136-1142
10
NHMRC 1999：Guidelines for the prevention, early detection and management of colorectal cancer. National Health and Medical Research Council,, 1999.
Nogueras JJ 1993：Nogueras JJ. Jagelman DG. Surgical Clinics of North America. 73(1):103-16, 1993 Feb.
NHS 2003：Guidance on Cancer Services, Improving outcomes in colorectal cancer: Updated Manual, September 2003
Polyp Guideline1993：Diagnosis, Treatment, and Surveillance for Patients with Nonfamilial Colorectal Polyps, Annals of Internal Medicine V olume 119(8) 15 October 1993 pp 836-843
RCSI 2002：Colorectal Cancer Management Clinical Guidelines ,Prepared by The Clinical Guidelines Committee Royal College of Surgeons in Ireland, November 2002
RAND 2000：Steven M. et al., Quality of Care for Oncologic Conditions and HIV: A Review of the Literature and Quality Indicators
SIGN 2003：Management of colorectal cancer. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2003 Mar. 47 p. (SIGN publication; no. 67). [256 references]
SSAT Patient Care Guidelines 2000：SSAT Patient Care Guidelines, Surgical Treatment of Cancer of the Colon or Rectum,2000.
THE LEAPFROG GROP：THE LEAPFROG GROP for Patient Safety Rewarding Higher Standards. Evidence-Based Hospital Referral.
Founded by the Business Roundtable with Support from the Robert Wood Johnson Foundation, revision 2004.
Willett 1994：Willett, Walter C.A Prospective Study of Family History and the Risk of Colorectal Cancer, N Engl J Med V olume 331(25)22 Dec 1994 pp 1669-1674
11
Guidelines 2001 RCSI 2002SIGN 2003 NHMRC
1999
Guidelines
2001
RCSI 2002
RAND Desch CE
A I Ia I Randomized
controlled trials
I Evidence obtained from meta-analysis of
multiple, well-designed, controlled studies.
Randomized trials with low false-positive and
low false-negative errors (high power)
A
II Ib II Evidence obtained from at least one
well-designed experimental study. Randomized
trials with high false-positive and/or
false-negative errors (low power)
III IIa II-1
Nonrandomized
controlled
trial
B
IIb III Evidence obtained from well-designed,
quasiexperimental studies such as
non-randomized, controlled, single-group,
pre-post, cohort, time, or matched case-control
series
B
C III II-2 Cohort or
case analysis
IV Evidence from well-designed, non-experimental
studies such as comparative and correlational
descriptive and case studies
II-3 Multiple time
series
C D IV IV III Opinions or
descriptive V Evidence from case reports and clinical examples
12
13。