Lindelöf Bernt, Krynitz Britta, Granath Fredrik, Ekbom Anders
Unit of Dermatology, Department of Medicine, Karolinska University Hospital and Institute, Stockholm, Sweden.
Acta Derm Venereol. 2008;88(1):20-2. doi: 10.2340/00015555-0339.
Development of malignant tumours in chronic burn wounds or scars is extremely rare, but a frequently reported complication. Most of these tumours are squamous cell carcinoma and, more occasionally, basal cell carcinoma and malignant melanoma are reported. The interval between the initial burn and the diagnosis of the tumour is usually long; 20-30 years or more. A large number of case reports and small series of selected patients have been published. Only one epidemiological study has been performed recently, but it could not confirm any increased risk. We conducted a historical cohort study to assess the risk of cancer in Swedish patients with burn injuries. Using the national Inpatient Registry we identified 37,095 patients who had been hospitalized for burn injuries. This cohort was linked with the Swedish Cancer Registry for a virtually complete follow-up with regard to cancer. The mean follow-up time was 16.4 years (range >0-39). The risk of developing any form of cancer was slightly increased: standardized incidence ratio (SIR) 1.11 (95% confidence interval (CI) 1.06-1.16) based on 2227 patients with cancer. However, squamous cell carcinoma: SIR 0.88 (95% CI 0.70-1.09) and malignant melanoma: SIR 0.88 (95% CI 0.68-1.12) did not occur more often than expected. Also, in a subgroup of 12,783 patients who were followed for 20-39 years, no increased risk of skin cancer could be detected. This study does not support any casual association between burn injuries and a later risk of skin cancer.
慢性烧伤创面或瘢痕中发生恶性肿瘤极为罕见，但却是一种经常报道的并发症。这些肿瘤大多为鳞状细胞癌，偶尔也有基底细胞癌和恶性黑色素瘤的报道。从最初烧伤到肿瘤诊断之间的间隔通常很长，为20至30年或更长时间。已经发表了大量的病例报告和少量选定患者的系列研究。最近仅进行了一项流行病学研究，但未能证实存在任何增加的风险。我们进行了一项历史性队列研究，以评估瑞典烧伤患者患癌症的风险。利用国家住院患者登记系统，我们确定了37095名因烧伤住院的患者。该队列与瑞典癌症登记系统相联系，以实现对癌症几乎完全的随访。平均随访时间为16.4年（范围>0至39年）。发生任何形式癌症的风险略有增加：基于2227名癌症患者，标准化发病比（SIR）为1.11（95%置信区间（CI）1.06 - 1.16）。然而，鳞状细胞癌：SIR为0.88（95%CI 0.70 - 1.09），恶性黑色素瘤：SIR为0.88（95%CI 0.68 - 1.12），其发生频率并未高于预期。此外，在随访20至39年的12783名患者亚组中，未检测到皮肤癌风险增加。这项研究不支持烧伤与后期皮肤癌风险之间存在任何因果关联。
