Iannacone Michelle R, Sinnya Sudipta, Pandeya Nirmala, Isbel Nikky, Campbell Scott, Fawcett Jonathan, Soyer Peter H, Ferguson Lisa, Davis Marcia, Whiteman David C, Green Adèle C
QIMR Berghofer Medical Research Institute, Population Health, Queensland, Australia.
Dermatology Research Centre, University of Queensland, School of Medicine, Translational Research Institute, Queensland, Australia.
J Invest Dermatol. 2016 Jul;136(7):1382-1386. doi: 10.1016/j.jid.2016.02.804. Epub 2016 Mar 9.
The increased skin cancer incidence in organ transplant recipients is well-known, but the skin cancer burden at any one time is unknown. Our objective was to estimate the period prevalence of untreated skin malignancy and actinic keratoses in high-risk kidney and liver transplant recipients and to assess associated factors. Organ transplant recipients underwent full skin examinations by dermatologically trained physicians. The proportion of examined organ transplant recipients with histopathologically confirmed skin cancer in the 3-month baseline period was estimated. Prevalence ratios with 95% confidence intervals indicated significant associations. Of 495 high-risk organ transplant recipients (average age = 54 years, time immunosuppressed = 8.9 years), 135 (27%) had basal cell carcinoma, squamous cell carcinoma or Bowen's disease (intraepidermal carcinoma) present and confirmed in the baseline period, with respective prevalence proportions of 10%, 11%, and 18% in kidney transplant recipients and 10%, 9%, and 13% in liver transplant recipients. Over 80% had actinic keratosis present, with approximately 30% having 5 or more actinic keratoses. Organ transplant recipients with the highest skin cancer burden were Australian born, were fair skinned (prevalence ratio = 1.61, 95% confidence interval = [1.07, 2.43]), reported past skin cancer (prevalence ratio =3.39, 95% confidence interval = [1.93, 5.95]), and were receiving the most frequent skin checks (prevalence ratio = 1.76, 95% confidence interval = [1.15, 2.70]). In conclusion, high-risk organ transplant recipients carry a substantial measurable skin cancer burden at any given time and require frequent review through easily accessible, specialized services.
器官移植受者皮肤癌发病率增加是众所周知的，但任一时刻的皮肤癌负担尚不明确。我们的目标是估计高危肾移植和肝移植受者未经治疗的皮肤恶性肿瘤和光化性角化病的期间患病率，并评估相关因素。器官移植受者接受了经过皮肤科培训的医生的全面皮肤检查。估计了在3个月基线期内经组织病理学确诊皮肤癌的受检器官移植受者比例。带有95%置信区间的患病率比值表明存在显著关联。在495名高危器官移植受者（平均年龄 = 54岁，免疫抑制时间 = 8.9年）中，135名（27%）在基线期患有基底细胞癌、鳞状细胞癌或鲍恩病（表皮内癌）并得到确诊，肾移植受者的患病率分别为10%、11%和18%，肝移植受者的患病率分别为10%、9%和13%。超过80%的人存在光化性角化病，约30%的人有5个或更多光化性角化病。皮肤癌负担最重的器官移植受者出生在澳大利亚，皮肤白皙（患病率比值 = 1.61，95%置信区间 = [1.07, 2.43]），曾患皮肤癌（患病率比值 = 3.39，95%置信区间 = [1.93, 5.95]），且接受皮肤检查的频率最高（患病率比值 = 1.76，95%置信区间 = [1.15, 2.70]）。总之，高危器官移植受者在任何给定时间都承担着相当大且可测量的皮肤癌负担，需要通过易于获得的专业服务进行频繁复查。
