补骨脂素和长波紫外线 A 疗法相关的鳞状细胞癌和基底细胞癌风险：一项 30 年的前瞻性研究。

The risk of squamous cell and basal cell cancer associated with psoralen and ultraviolet A therapy: a 30-year prospective study.

机构信息

Department of Dermatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.

出版信息

J Am Acad Dermatol. 2012 Apr;66(4):553-62. doi: 10.1016/j.jaad.2011.04.004. Epub 2012 Jan 20.

DOI:10.1016/j.jaad.2011.04.004

PMID:22264671

Abstract

BACKGROUND

By 1977, psoralen and ultraviolet A (PUVA) was established as a highly effective therapy for psoriasis. Because of concerns about potential long-term adverse effects, particularly cancer, the PUVA Follow-Up Study was established to assess long-term risk and benefits of PUVA.

OBJECTIVE

We sought to determine the association of certain squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) risk with exposure to PUVA.

METHODS

For nearly 30 years, this prospective cohort study of 1380 patients with psoriasis first treated with PUVA in 1975 to 1976 documented exposures and incident events including biopsy-proven skin cancers.

RESULTS

From 1975 to 2005, 351 of 1380 (25%) cohort patients developed 2973 biopsy-proven SCC and 330 (24%) developed 1729 BCCs. After adjusting for age, gender, and significant confounders, the risk of developing one or more SCC in a year was strongly associated with total number of PUVA treatments (350-450 vs <50 treatments, incidence rate ratio [IRR] = 6.01, 95% confidence interval [CI] = 4.41-8.20). When all tumors are included this risk is significantly higher (IRR = 20.92, 95% CI = 14.08-31.08). Corresponding risks for BCC were much lower (person counts IRR = 3.09, 95% CI = 2.36-4.06; tumor counts IRR = 2.12, 95% CI = 1.47-3.05).

LIMITATIONS

This was an observational prospective study of a cohort with severe psoriasis. An unknown factor associated with higher dose exposure to PUVA in our cohort that was not included in our analysis could account for the observed associations.

CONCLUSION

Exposure to more than 350 PUVA treatments greatly increases the risk of SCC. Exposure to fewer than 150 PUVA treatments has, at most, modest effects on SCC risk. Even high-dose exposure to PUVA does not greatly increase BCC risk. The risks of SCC in long-term PUVA-treated patients should be considered in determining the risk of this therapy relative to other treatments for severe psoriasis.

摘要

背景

到 1977 年，补骨脂素和紫外线 A（PUVA）已被确立为治疗银屑病的一种非常有效的疗法。由于担心潜在的长期不良影响，特别是癌症，因此建立了 PUVA 随访研究来评估 PUVA 的长期风险和益处。

目的

我们旨在确定某些鳞状细胞癌（SCC）和基底细胞癌（BCC）风险与 PUVA 暴露之间的关联。

方法

在将近 30 年的时间里，这项针对 1380 名于 1975 年至 1976 年间首次接受 PUVA 治疗的银屑病患者的前瞻性队列研究记录了暴露情况和包括活检证实的皮肤癌在内的发病事件。

结果

从 1975 年到 2005 年，1380 名队列患者中的 351 名（25％）发展为 2973 例活检证实的 SCC 和 330 名（24％）发展为 1729 例 BCC。在调整年龄、性别和重要混杂因素后，一年内发生一种或多种 SCC 的风险与 PUVA 治疗的总数（350-450 次 vs <50 次，发病率比[IRR] = 6.01，95％置信区间[CI] = 4.41-8.20）密切相关。当包括所有肿瘤时，这种风险更高（IRR = 20.92，95％CI = 14.08-31.08）。BCC 的相应风险要低得多（人数 IRR = 3.09，95％CI = 2.36-4.06；肿瘤人数 IRR = 2.12，95％CI = 1.47-3.05）。

局限性

这是一项针对严重银屑病队列的观察性前瞻性研究。我们的队列中存在与较高剂量的 PUVA 暴露相关的未知因素，而该因素未包含在我们的分析中，可能导致了观察到的关联。

结论

暴露于超过 350 次 PUVA 治疗会大大增加 SCC 的风险。暴露于少于 150 次 PUVA 治疗最多只会适度增加 SCC 风险。即使高剂量暴露于 PUVA 也不会大大增加 BCC 的风险。在确定相对于其他治疗严重银屑病的疗法的这种疗法的风险时，应考虑长期接受 PUVA 治疗的患者的 SCC 风险。