Adult Cancer Program, Lowy Cancer Research Center, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
Adult Cancer Program, Lowy Cancer Research Center, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; Center for Big Data Research in Health, University of New South Wales, Sydney, Australia.
J Am Acad Dermatol. 2016 Jun;74(6):1144-1152.e6. doi: 10.1016/j.jaad.2015.12.044. Epub 2016 Jan 30.
Iatrogenic immunosuppression is a risk factor for lip cancer but the determinants are unknown.
We sought to quantify the association between the type, dose, and duration of iatrogenic immunosuppression and lip cancer risk in solid organ transplant recipients.
We conducted a population-based cohort study of all adult Australian liver, heart, and lung transplant recipients from 1984 to 2006 (n = 4141). We abstracted longitudinal data from medical records and ascertained incident lip cancer (n = 58) and deaths (n = 1434) by linkage with national registries. We estimated multivariable hazard ratios (HR) for lip cancer using the Fine and Gray proportional subdistribution hazards model, accounting for death as a competing risk.
Lip cancer risk (n = 58) increased with high mean daily dose of azathioprine (HR 2.28, 95% confidence interval [CI] 1.18-4.38), longer duration of immunosuppression (HR 9.86, 95% CI 2.10-46.3), increasing year of age at transplantation (HR 1.14, 95% CI 1.04-1.25), earlier transplantation era (HR 8.73, 95% CI 1.11-68.7), and history of smoking (HR 2.71, 95% CI 1.09-6.70).
Data on potential confounders such as personal solar ultraviolet radiation exposure were not available.
Higher doses of azathioprine increase lip cancer risk, with implications for managing immunosuppressed populations and our understanding of the relationship between solar ultraviolet radiation and lip cancer.
医源性免疫抑制是唇癌的一个危险因素，但具体的决定因素尚不清楚。
我们旨在量化实体器官移植受者的医源性免疫抑制的类型、剂量和持续时间与唇癌风险之间的关联。
我们对 1984 年至 2006 年期间所有澳大利亚肝、心和肺移植受者（n=4141）进行了一项基于人群的队列研究。我们从病历中提取纵向数据，并通过与国家登记处的链接确定了唇癌（n=58）和死亡（n=1434）的发病情况。我们使用 Fine 和 Gray 比例亚分布风险模型估计了多变量风险比（HR），将死亡作为竞争风险进行考虑。
唇癌风险（n=58）随硫唑嘌呤的平均日高剂量（HR 2.28，95%置信区间[CI]1.18-4.38）、免疫抑制的持续时间更长（HR 9.86，95%CI2.10-46.3）、移植时年龄增加（HR 1.14，95%CI1.04-1.25）、更早的移植时代（HR 8.73，95%CI1.11-68.7）和吸烟史（HR 2.71，95%CI1.09-6.70）而增加。
没有关于潜在混杂因素（如个人太阳紫外线暴露）的数据。
较高剂量的硫唑嘌呤会增加唇癌风险，这对管理免疫抑制人群和我们对太阳紫外线与唇癌之间关系的理解具有重要意义。
