Department of Dermatology, Cardinal Tien Hospital, New Taipei City, Taiwan.
School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.
Br J Dermatol. 2016 Dec;175(6):1175-1182. doi: 10.1111/bjd.14789. Epub 2016 Oct 12.
Patients on chronic haemodialysis (HD) have a higher incidence of cancer. However, the risk of skin cancer in this population has rarely been investigated.
To investigate the risk of nonmelanoma skin cancer (NMSC) and cutaneous melanoma in patients on chronic HD and to explore the associated risk factors.
We performed retrospective cohort and nested case-control studies using records in the Taiwanese National Health Insurance Research Database between 1999 and 2013. The HD cohort included 79 668 incident patients on HD, for whom the standardized incidence ratios (SIRs) for incident NMSC and cutaneous melanoma were determined. In the nested case-control study, patients on HD with NMSC were matched to those without skin cancers. The impact of various factors on the development of NMSC was determined by conditional logistic regression analysis.
Among the 79 668 patients on HD, 248 cases of NMSC and 22 cases of cutaneous melanoma occurred after a mean 4·95 years of follow-up. The SIRs for NMSC and cutaneous melanoma in patients on HD were 1·58 (95% confidence interval 1·39-1·79) and 1·44 (95% confidence interval 0·91-2·19), respectively. Of the patients on HD, a higher risk of NMSC was found in men (1·5-fold), South Taiwan residents (twofold) and patients with uraemic pruritus after long-term antihistamine treatment (1·53-fold). However, the incidence of NMSC was not increased in patients with uraemic pruritus receiving ultraviolet B phototherapy.
Patients on chronic HD are at higher risk of NMSC. Uraemic pruritus further increases the risk of NMSC, which might be prevented by ultraviolet B phototherapy.
慢性血液透析（HD）患者癌症发病率较高。然而，该人群皮肤癌的风险很少被研究。
研究慢性 HD 患者非黑色素瘤皮肤癌（NMSC）和皮肤黑色素瘤的发病风险，并探讨相关的危险因素。
我们使用台湾全民健康保险研究数据库在 1999 年至 2013 年期间的记录进行了回顾性队列和嵌套病例对照研究。HD 队列包括 79668 例新诊断的 HD 患者，确定了新诊断 NMSC 和皮肤黑色素瘤的标准化发病比（SIR）。在嵌套病例对照研究中，将患有 NMSC 的 HD 患者与无皮肤癌的患者相匹配。通过条件逻辑回归分析确定各种因素对 NMSC 发生的影响。
在 79668 例 HD 患者中，在平均 4.95 年的随访后，有 248 例 NMSC 和 22 例皮肤黑色素瘤患者发生。HD 患者 NMSC 和皮肤黑色素瘤的 SIR 分别为 1.58（95%置信区间 1.39-1.79）和 1.44（95%置信区间 0.91-2.19）。在 HD 患者中，男性（1.5 倍）、台湾南部居民（2 倍）和接受长期抗组胺治疗后出现尿毒症瘙痒的患者（1.53 倍）NMSC 的风险更高。然而，接受紫外线 B 光疗的尿毒症瘙痒患者，NMSC 的发病率并未增加。
慢性 HD 患者患 NMSC 的风险较高。尿毒症瘙痒进一步增加了 NMSC 的风险，紫外线 B 光疗可能预防其发生。
