Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.
J Am Acad Dermatol. 2011 Jul;65(1):84-91. doi: 10.1016/j.jaad.2010.04.046. Epub 2011 Mar 31.
An association between psoriasis and malignancy has been explored. However, no studies have been reported regarding cancer risk in Asian psoriasis populations.
The aim of this study was to investigate the risk of cancer development in association with psoriasis. The effects of age at diagnosis, treatment modalities, and observation time were also evaluated.
Data for this retrospective population-based cohort study were obtained from the Taiwan National Health Insurance Research Database (NHIRD). This study included 3,686 patients with first-time diagnosis of psoriasis between 1996 and 2000. Another 200,000 patients without psoriasis served as the comparison group. All enrolled subjects were followed-up until the end of 2007. Cumulative incidences and hazard ratios (HRs) of cancer development were determined.
Among the 3,686 psoriasis patients, 116 had incident cancers. The 7-year cumulative incidence of cancer among psoriasis patients was 4.8%. The adjusted HR for developing a cancer in association with psoriasis was 1.66 (95% confidence interval [CI], 1.38-2.00). Cancer risk was higher in male patients than in female patients (adjusted HR 1.86 vs.1.14, respectively). Certain cancers were significantly associated with psoriasis, including those of the urinary bladder and skin, followed by oropharynx/larynx, liver/gallbladder, and colon/rectum. Patients with psoriasis had an increased adjusted HR for cancer that varied by age. Younger patients with psoriasis tended to have the greatest risk of cancer. Finally, systemic phototherapy and oral medication did not significantly increase the risk of cancer. Phototherapy with UVB appeared to reduce the risk of cancer in psoriasis (adjusted HR, 0.52; 95% CI, 0.29-0.95; P = .03).
NHIRD did not contain information regarding severity of psoriasis, status of smoking, alcohol use, family history of cancer, or diet. Misclassification of disease cannot be ruled out in a registry-based database.
Psoriasis carries an elevated risk of malignancies, especially in younger and in male patients. This effect is independent of systemic treatment for psoriasis. Finally, phototherapy with UVB did not increase, but rather reduced, the risk of cancer in psoriasis.
已经探讨了银屑病和恶性肿瘤之间的关联。然而，尚未有研究报告亚洲银屑病人群的癌症风险。
本研究旨在调查银屑病与癌症发展之间的风险关联。还评估了诊断时的年龄、治疗方式和观察时间的影响。
这项回顾性基于人群的队列研究的数据来自于台湾全民健康保险研究数据库（NHIRD）。该研究纳入了 1996 年至 2000 年间首次诊断为银屑病的 3686 例患者。另外 200000 例无银屑病的患者作为对照组。所有入组的患者均随访至 2007 年底。确定癌症发展的累积发生率和风险比（HR）。
在 3686 例银屑病患者中，有 116 例发生了癌症。银屑病患者的 7 年累积癌症发生率为 4.8%。银屑病患者发生癌症的调整 HR 为 1.66（95%置信区间[CI]，1.38-2.00）。男性患者的癌症风险高于女性患者（调整 HR 分别为 1.86 和 1.14）。某些癌症与银屑病显著相关，包括膀胱癌和皮肤癌，其次是口咽/喉癌、肝癌/胆囊癌和结肠癌/直肠癌。银屑病患者的癌症调整 HR 随年龄而变化。年轻的银屑病患者患癌症的风险最大。最后，全身光疗和口服药物并未显著增加癌症风险。UVB 光疗似乎降低了银屑病患者的癌症风险（调整 HR，0.52；95%CI，0.29-0.95；P =.03）。
NHIRD 不包含银屑病严重程度、吸烟、饮酒、癌症家族史或饮食的信息。在基于登记的数据库中，疾病的分类错误无法排除。
银屑病患者患恶性肿瘤的风险增加，尤其是年轻和男性患者。这种影响独立于银屑病的全身治疗。最后，UVB 光疗并未增加反而降低了银屑病患者的癌症风险。
