Karagas M R, Stukel T A, Greenberg E R, Baron J A, Mott L A, Stern R S
Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755-3861.
JAMA. 1992 Jun 24;267(24):3305-10.
The primary aims of this study were to assess risk of subsequent basal and squamous cell skin cancer among patients with a prior history of these tumors and to examine these risks in relation to patient characteristics and life-style factors.
Follow-up of participants in a randomized trial of betacarotene as a possible skin cancer preventive agent.
Clinical centers in Los Angeles, Calif, San Francisco, Calif, Minneapolis, Minn, and Hanover, NH.
Patients (n = 1805) who were diagnosed as having a basal or squamous cell skin cancer between January 1980 and February 1986 and were free of skin cancer at study entry.
Time from study entry to first new occurrence of basal and squamous cell skin cancer.
The estimated risk of developing one or more new skin cancers was 35% at 3 years and 50% at 5 years. New skin cancers tended to be of the same cell type as the previous skin cancers. For both basal and squamous cell skin cancer, risk was higher among patients who were male, were over the age of 60 years, had more prior skin cancers, had severe actinic skin damage, or who burned easily with sun exposure. Compared with those who had never smoked, the rate of subsequent squamous cell skin cancer was higher among current smokers (rate ratio, 2.01; 95% confidence interval, 1.21 to 3.34) and former smokers (rate ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and increased with both duration and amount smoked. There was no clear relationship between smoking and basal cell skin cancer; the rate appeared lower among heavy smokers but was unrelated to duration of smoking.
Persons with a prior nonmelanoma skin cancer had a substantial 5-year risk of developing another tumor of the same histologic type. Number of previous skin cancers, solar damage, and skin sensitivity to sun exposure were particularly related to this risk. The increased risk of squamous cell skin cancer associated with cigarette smoking merits further study.
本研究的主要目的是评估曾患基底细胞和鳞状细胞皮肤癌的患者后续发生此类肿瘤的风险，并探讨这些风险与患者特征及生活方式因素之间的关系。
对一项将β-胡萝卜素作为可能的皮肤癌预防剂的随机试验参与者进行随访。
加利福尼亚州洛杉矶、加利福尼亚州旧金山、明尼苏达州明尼阿波利斯和新罕布什尔州汉诺威的临床中心。
1980年1月至1986年2月期间被诊断患有基底细胞或鳞状细胞皮肤癌且在研究开始时无皮肤癌的患者（n = 1805）。
从研究开始到首次新发基底细胞和鳞状细胞皮肤癌的时间。
3年时发生一种或多种新皮肤癌的估计风险为35%，5年时为50%。新发皮肤癌往往与先前皮肤癌的细胞类型相同。对于基底细胞和鳞状细胞皮肤癌，男性、60岁以上、既往有更多皮肤癌、有严重光化性皮肤损伤或日晒易晒伤的患者风险更高。与从不吸烟者相比，当前吸烟者（率比，2.01；95%置信区间，1.21至3.34）和既往吸烟者（率比，1.62；95%置信区间，1.07至2.47）后续鳞状细胞皮肤癌的发生率更高，且随吸烟持续时间和吸烟量增加而升高。吸烟与基底细胞皮肤癌之间无明确关系；重度吸烟者的发生率似乎较低，但与吸烟持续时间无关。
既往有非黑色素瘤皮肤癌的人在5年内有相当大的风险发生另一例相同组织学类型的肿瘤。既往皮肤癌的数量、日光损伤和皮肤对日晒的敏感性与该风险尤其相关。吸烟与鳞状细胞皮肤癌风险增加之间的关系值得进一步研究。
