Chen Jiping, Ruczinski Ingo, Jorgensen Timothy J, Yenokyan Gayane, Yao Yin, Alani Rhoda, Liégeois Nanette J, Hoffman Sandra C, Hoffman-Bolton Judith, Strickland Paul T, Helzlsouer Kathy J, Alberg Anthony J
Division of Cancer Prevention, National Cancer Institute, Rockville, MD, USA.
J Natl Cancer Inst. 2008 Sep 3;100(17):1215-22. doi: 10.1093/jnci/djn260. Epub 2008 Aug 26.
Individuals with a personal history of nonmelanoma skin cancer (NMSC) may have an increased risk of subsequent noncutaneous malignancies. To test this hypothesis, we carried out a community-based, prospective cohort study.
In the CLUE (Give Us a Clue to Cancer and Heart Disease) II cohort, which was established in Washington County, MD, in 1989, the risk of new malignancies was compared among individuals with (n = 769) and without (n = 18,405) a personal history of NMSC (total n = 19,174) during a 16-year follow-up period. Pathologically confirmed NMSC (and other malignancies) were ascertained from the Washington County Cancer Registry. Cox regression analysis with time-dependent covariates was used to determine the hazard ratios (presented as multivariable-adjusted relative risks [RRs]) and 95% confidence intervals (CIs) of second primary malignancies associated with a previously confirmed NMSC diagnosis. All statistical tests were two-sided.
The crude incidence rate (per 10,000 person-years) of subsequent cancers other than NMSC among participants with a positive personal history of NMSC was 293.5 and with a negative history was 77.8. Compared with persons with no personal history of NMSC, those with such a history had a statistically significantly increased risk of being diagnosed with a subsequent cancer other than NMSC (RR = 1.99, 95% CI = 1.70 to 2.33) after adjusting for age, sex, body mass index, smoking status, and educational level. The association was observed for both basal cell carcinoma (multivariable-adjusted RR = 2.03, 95% CI = 1.70 to 2.42) and squamous cell carcinoma (multivariable-adjusted RR = 1.97, 95% CI = 1.50 to 2.59) of the skin. NMSC was a statistically significantly stronger cancer risk factor in younger age groups than in older age groups (P for interaction = .022).
This community-based, prospective cohort study provides evidence for an association between an NMSC diagnosis and an increased risk of subsequent cancer, even after adjusting for individual-level risk factors.
有非黑色素瘤皮肤癌（NMSC）个人病史的个体后续发生非皮肤恶性肿瘤的风险可能会增加。为验证这一假设，我们开展了一项基于社区的前瞻性队列研究。
在1989年于马里兰州华盛顿县建立的CLUE（给我们癌症和心脏病线索）II队列中，比较了有NMSC个人病史（n = 769）和无NMSC个人病史（n = 18,405）的个体（共n = 19,174）在16年随访期内发生新恶性肿瘤的风险。通过华盛顿县癌症登记处确定病理确诊的NMSC（及其他恶性肿瘤）。采用具有时间依赖性协变量的Cox回归分析来确定与先前确诊的NMSC诊断相关的第二原发性恶性肿瘤的风险比（以多变量调整相对风险[RRs]表示）和95%置信区间（CIs）。所有统计检验均为双侧检验。
有NMSC个人病史阳性的参与者中，除NMSC外的后续癌症的粗发病率（每10,000人年）为293.5，无该病史的为77.8。在调整年龄、性别、体重指数、吸烟状况和教育水平后，与无NMSC个人病史的人相比，有该病史的人被诊断为除NMSC外的后续癌症的风险在统计学上显著增加（RR = 1.99，95% CI = 1.70至2.33）。在皮肤基底细胞癌（多变量调整RR = 2.03，95% CI = 1.70至2.42）和鳞状细胞癌（多变量调整RR = 1.97，95% CI = 1.50至2.59）中均观察到这种关联。在较年轻年龄组中，NMSC是比老年年龄组更强的癌症风险因素（交互作用P = 0.022）。
这项基于社区的前瞻性队列研究为NMSC诊断与后续癌症风险增加之间的关联提供了证据，即使在调整个体水平的风险因素后亦是如此。
