Department of Dermatology, University Hospital Zürich, Zürich, Switzerland.
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland.
Br J Dermatol. 2017 May;176(5):1179-1186. doi: 10.1111/bjd.15269. Epub 2017 Apr 10.
Organ transplant recipients (OTRs) have a highly increased risk of cutaneous squamous cell carcinomas (SCCs). Sensation of pain in cutaneous tumours is a powerful patient-reported warning signal for invasive SCCs in OTRs.
To investigate the impact of painful vs. painless skin lesions and SCC vs. other skin lesions on the overall mortality risk in OTRs.
We followed 410 OTRs from 10 different centres across Europe and North America between 2008 and 2015. These patients had been enrolled in an earlier study to define clinically meaningful patient-reported warning signals predicting the presence of SCC, and had been included if they had a lesion requiring histological diagnosis. Cumulative incidences of overall mortality were calculated using Kaplan-Meier survival analysis, and risk factors were analysed with Cox proportional hazard analysis.
There was an increased overall mortality risk in OTRs who reported painful vs. painless skin lesions, with a hazard ratio (HR) of 1·6 [95% confidence interval (CI) 0·97-2·7], adjusted for age, sex and other relevant factors. There was also an increased overall mortality risk in OTRs diagnosed with SCC compared with other skin lesions, with an adjusted HR of 1·7 (95% CI 1·0-2·8). Mortality due to internal malignancies and systemic infections appeared to prevail in OTRs with SCC.
We suggest that OTRs have an increased overall mortality risk if they develop painful skin lesions or are diagnosed with cutaneous SCC.
器官移植受者（OTR）罹患皮肤鳞状细胞癌（SCC）的风险极高。皮肤肿瘤的疼痛感知是 OTR 侵袭性 SCC 的有力患者报告预警信号。
探讨有痛 vs. 无痛皮肤病变以及 SCC vs. 其他皮肤病变对 OTR 总体死亡率风险的影响。
我们在 2008 年至 2015 年间，对来自欧洲和北美的 10 个不同中心的 410 名 OTR 进行了随访。这些患者曾参与过一项早期研究，以确定具有临床意义的患者报告预警信号，预测 SCC 的存在，并纳入了需要组织学诊断的病变患者。使用 Kaplan-Meier 生存分析计算总体死亡率的累积发生率，并使用 Cox 比例风险分析分析风险因素。
与无痛皮肤病变相比，报告有痛皮肤病变的 OTR 总体死亡率风险增加，调整年龄、性别和其他相关因素后，风险比（HR）为 1.6（95%CI 0.97-2.7）。与其他皮肤病变相比，诊断为 SCC 的 OTR 总体死亡率风险也增加，调整后的 HR 为 1.7（95%CI 1.0-2.8）。SCC 患者的死亡原因似乎主要是内部恶性肿瘤和全身感染。
如果 OTR 出现疼痛性皮肤病变或诊断为皮肤 SCC，我们建议其总体死亡率风险增加。
