Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Department of Medical Oncology, Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts.
JAMA Dermatol. 2014 Mar;150(3):280-7. doi: 10.1001/jamadermatol.2013.6249.
Although it has been well established that patients with chronic lymphocytic leukemia (CLL) have an increased risk of developing skin cancer, few studies have investigated the effect of CLL stage on the risk of poor skin cancer outcomes. The present study of CLL staging assesses outcomes of melanoma, squamous cell carcinoma, and Merkel cell carcinoma in this high-risk population.
To determine if progression of CLL measured by advanced Rai stage (III or IV) is associated with worse skin cancer outcomes.
DESIGN, SETTING, AND PARTICIPANTS: Twenty-year retrospective study at 2 academic centers in Boston, Massachusetts, of adults with CLL and either melanoma, squamous cell carcinoma, or Merkel cell carcinoma.
Hazard ratios (HRs) for the development of poor skin cancer outcomes (local recurrence, nodal metastasis, distant metastasis, or death from skin cancer).
In total, 133 patients with 377 primary skin cancers and a median follow-up of 41 months were included. Squamous cell carcinoma predominated (92.0%). The risk of death from skin cancer was equivalent to the risk of death from CLL (13.5%). On multivariate analysis, advanced Rai stage (III or IV) at the time of the first skin cancer diagnosis (HR, 4.5; 95% CI, 2.3-8.9) and a high skin cancer tumor (T) stage (HR, 4.9; 95% CI, 2.2-10.8) were associated with poor skin cancer outcomes. Those with both a low skin cancer T stage and a low Rai stage (n = 265) had a low risk (5.3%; 95% CI, 3.2%-8.7%) of poor skin cancer outcomes. Those with a low T stage and a high Rai stage (n = 89) had a significantly higher risk of poor skin cancer outcomes (16.9%; 95% CI, 10.9%-26.0%). The 23 patients with a high T stage had high risks of poor outcomes regardless of CLL status (27.3% if a low Rai stage and 50.0% if a high Rai stage, with wide 95% CIs).
In patients with CLL and non-basal cell carcinoma skin cancer, mortality is as high from skin cancer as from CLL. The Rai stage and skin cancer T stage should be considered when risk-stratifying patients with skin cancer. Regular communication between dermatologists and oncologists will help facilitate the identification of patients with CLL who are at high risk of having poor skin cancer outcomes.
虽然已经明确慢性淋巴细胞白血病（CLL）患者发生皮肤癌的风险增加，但很少有研究调查 CLL 分期对皮肤癌不良结局风险的影响。本研究评估了 CLL 分期对黑色素瘤、鳞状细胞癌和 Merkel 细胞癌的影响，这是高危人群中的皮肤癌。
确定 CLL 的进展（通过高级 Rai 分期（III 或 IV）测量）是否与皮肤癌不良结局相关。
设计、地点和参与者：这是一项在马萨诸塞州波士顿的 2 个学术中心进行的 20 年回顾性研究，纳入了患有 CLL 且患有黑色素瘤、鳞状细胞癌或 Merkel 细胞癌的成年人。
皮肤癌不良结局（局部复发、淋巴结转移、远处转移或皮肤癌死亡）的风险比（HR）。
共纳入 133 例患者的 377 例原发性皮肤癌，中位随访时间为 41 个月。鳞状细胞癌占主导地位（92.0%）。皮肤癌死亡的风险与 CLL 死亡的风险相当（13.5%）。多变量分析显示，首次皮肤癌诊断时的高级 Rai 分期（III 或 IV）（HR，4.5；95%CI，2.3-8.9）和高皮肤癌 T 分期（HR，4.9；95%CI，2.2-10.8）与皮肤癌不良结局相关。那些 Rai 分期低且皮肤癌 T 分期低的患者（n=265）皮肤癌不良结局的风险较低（5.3%；95%CI，3.2%-8.7%）。那些 Rai 分期高且皮肤癌 T 分期低的患者（n=89）皮肤癌不良结局的风险显著更高（16.9%；95%CI，10.9%-26.0%）。23 例 T 分期高的患者无论 CLL 状态如何，皮肤癌不良结局的风险均较高（低 Rai 分期时为 27.3%，高 Rai 分期时为 50.0%，95%CI 较宽）。
在患有 CLL 和非基底细胞皮肤癌的患者中，皮肤癌的死亡率与 CLL 相当。在对皮肤癌患者进行风险分层时，应考虑 Rai 分期和皮肤癌 T 分期。皮肤科医生和肿瘤医生之间的定期沟通将有助于识别出皮肤癌不良结局风险较高的 CLL 患者。
