Cahoon Elizabeth K, Engels Eric A, Freedman D Michal, Norval Mary, Pfeiffer Ruth M
Affiliations of authors: Radiation Epidemiology Branch (EKC, MF), Infectious and Immunoepidemiology Branch (EAE), and Biostatistics Branch (RMP), Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Biomedical Sciences, University of Edinburgh Medical School, Edinburgh, Scotland (MN).
J Natl Cancer Inst. 2016 Dec 31;109(5). doi: 10.1093/jnci/djw267. Print 2017 May.
Although ultraviolet radiation (UVR) is established as both an inducer of herpes simplex virus reactivation and as the primary risk factor for many common skin cancers, its relationship with human herpes virus 8 (HHV8) infection or risk of Kaposi sarcoma (KS) is unknown.
Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for the association between ambient UVR, history of nonmelanoma skin cancer (NMSC; as a biomarker of personal cumulative UVR dose), and incidence of first primary KS in a nationwide US cohort of white and African American male veterans infected with HIV between 1986 and 1996 (prior to the widespread availability of treatment) using Cox regression. All statistical tests were two-sided.
Based on discharge records, there were 422 newly diagnosed KS cases among 17 597 HIV-infected veterans. Cohort members with prior NMSC had a statistically significantly increased risk of KS (HR = 8.64, 95% CI = 6.23 to 11.96) in the total population. Risk of KS was higher for quartile 4 vs 1 among the total population (HR = 1.49, 95% CI = 1.02 to 2.16, P UVR quartile [coded 1 to 4] = .02) and among whites (HR = 1.75, 95% CI = 1.11 to 2.78, P = .009), but not among African Americans (HR = 1.23, 95% CI = 0.71 to 2.15, P = .23).
KS risk was elevated among HIV-infected men with NMSC diagnosis and in those living in locations with high ambient UVR at time of HIV diagnosis. Our novel findings suggesting that UVR exposure may increase KS risk warrant further investigation.
尽管紫外线辐射（UVR）已被确认为单纯疱疹病毒再激活的诱导因素以及许多常见皮肤癌的主要危险因素，但其与人类疱疹病毒8（HHV8）感染或卡波西肉瘤（KS）风险之间的关系尚不清楚。
利用Cox回归，在美国一个全国性队列中，对1986年至1996年（治疗广泛普及之前）感染HIV的白人和非裔美国男性退伍军人进行研究，估计环境UVR、非黑色素瘤皮肤癌病史（NMSC；作为个人累积UVR剂量的生物标志物）与首例原发性KS发病率之间的关联的风险比（HRs）和95%置信区间（CIs）。所有统计检验均为双侧检验。
根据出院记录，在17597名感染HIV的退伍军人中，有422例新诊断的KS病例。在总人群中，既往有NMSC的队列成员患KS的风险在统计学上显著增加（HR = 8.64，95% CI = 6.23至11.96）。在总人群中，第4四分位数组患KS的风险高于第1四分位数组（HR = 1.49，95% CI = 1.02至2.16，P UVR四分位数[编码为1至4] =.02），在白人中也是如此（HR = 1.75，95% CI = 1.11至2.78，P =.009），但在非裔美国人中并非如此（HR = 1.23，95% CI = 0.71至2.15，P =.23）。
在诊断为NMSC的HIV感染男性以及HIV诊断时居住在环境UVR高的地区的男性中，KS风险升高。我们的新发现表明UVR暴露可能增加KS风险，值得进一步研究。
