Rees Judy R, Zens M Scot, Gui Jiang, Celaya Maria O, Riddle Bruce L, Karagas Margaret R
Geisel School of Medicine at Dartmouth, Department of Community and Family Medicine, Biostatistics and Epidemiology Section, Lebanon, New Hampshire, United States of America; New Hampshire State Cancer Registry, Hanover, New Hampshire, United States of America.
Geisel School of Medicine at Dartmouth, Department of Community and Family Medicine, Biostatistics and Epidemiology Section, Lebanon, New Hampshire, United States of America.
PLoS One. 2014 Jun 17;9(6):e99674. doi: 10.1371/journal.pone.0099674. eCollection 2014.
Several studies have shown an increased risk of cancer after non melanoma skin cancers (NMSC) but the individual risk factors underlying this risk have not been elucidated, especially in relation to sun exposure and skin sensitivity to sunlight.
The aim of this study was to examine the individual risk factors associated with the development of subsequent cancers after non melanoma skin cancer.
Participants in the population-based New Hampshire Skin Cancer Study provided detailed risk factor data, and subsequent cancers were identified via linkage with the state cancer registry. Deaths were identified via state and national death records. A Cox proportional hazard model was used to estimate risk of subsequent malignancies in NMSC patients versus controls and to assess the potential confounding effects of multiple risk factors on this risk.
Among 3584 participants, risk of a subsequent cancer (other than NMSC) was higher after basal cell carcinoma (BCC) (adjusted HR 1.40 [95% CI 1.15, 1.71]) than squamous cell carcinoma (SCC) (adjusted HR 1.18 [95% CI 0.95, 1.46]) compared to controls (adjusted for age, sex and current cigarette smoking). After SCC, risk was higher among those diagnosed before age 60 (HR 1.96 [95% CI 1.24, 3.12]). An over 3-fold risk of melanoma after SCC (HR 3.62; 95% CI 1.85, 7.11) and BCC (HR 3.28; 95% CI 1.66, 6.51) was observed, even after further adjustment for sun exposure-related factors and family history of skin cancer. In men, prostate cancer incidence was higher after BCC compared to controls (HR 1.64; 95% CI 1.10, 2.46).
Our population-based study indicates an increased cancer risk after NMSC that cannot be fully explained by known cancer risk factors.
多项研究表明，非黑素瘤皮肤癌（NMSC）后患癌风险增加，但这种风险背后的个体风险因素尚未阐明，尤其是与阳光暴露和皮肤对阳光的敏感性相关的因素。
本研究的目的是检查与非黑素瘤皮肤癌后发生后续癌症相关的个体风险因素。
基于人群的新罕布什尔州皮肤癌研究的参与者提供了详细的风险因素数据，并通过与州癌症登记处的链接确定了后续癌症。通过州和国家死亡记录确定死亡情况。使用Cox比例风险模型估计NMSC患者与对照组发生后续恶性肿瘤的风险，并评估多种风险因素对该风险的潜在混杂影响。
在3584名参与者中，与对照组相比（根据年龄、性别和当前吸烟情况进行调整），基底细胞癌（BCC）后发生后续癌症（非NMSC）的风险高于鳞状细胞癌（SCC）（调整后HR 1.40 [95% CI 1.15, 1.71]）（调整后HR 1.18 [95% CI 0.95, 1.46]）。在SCC后，60岁之前被诊断出的患者风险更高（HR 1.96 [95% CI 1.24, 3.12]）。即使在进一步调整与阳光暴露相关的因素和皮肤癌家族史后，SCC（HR 3.62；95% CI 1.85, 7.11）和BCC（HR 3.28；95% CI 1.66, 6.51）后发生黑色素瘤的风险仍高出3倍以上。在男性中，BCC后前列腺癌的发病率高于对照组（HR 1.64；95% CI 1.10, 2.46）。
我们基于人群的研究表明，NMSC后患癌风险增加，而已知的癌症风险因素无法完全解释这一现象。
