Department of Digestive Diseases, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
Department of Dermatology, Hospices Civils de Lyon, Edouard Herriot Hospital, Lyon, France.
J Am Acad Dermatol. 2018 Jul;79(1):84-91. doi: 10.1016/j.jaad.2017.12.063. Epub 2018 Jan 4.
Nonmelanoma skin cancers (NMSCs) are the most frequent cancers in solid organ transplant recipients, with a high rate of subsequent tumors.
To describe subsequent NMSCs in a large cohort of liver transplant recipients (LTRs) with long follow-up and analyze the factors influencing it, including immunosuppressive regimen.
A total of 96 LTRs (76 male) with a personal post-transplant history of squamous cell carcinoma, basal cell carcinoma or Bowen's disease were included, with a median follow-up of 12.4 years (range, 1.5-27.8) after liver transplantation.
The median follow-up after first NMSC was 6.4 years (range, 0.17-22.1). In all, 52 patients (53.1%) developed 141 subsequent NMSCs with a basal cell carcinoma-to-squamous cell carcinoma ratio of 1.8:1. The actuarial risk for development of a second NMSC was 13.7% at 1 year, 28.4% at 2 years, 49.4% at 5 years, 65.7% at 10 years, and 88.4% at 15 years. Multivariate analysis found that skin phototype I or II (vs III or IV) was a significant risk factor for development of a second NMSC (hazard ratio, 2.556; 95% confidence interval, 1.45-4.48; P = .001), whereas withdrawal of calcineurin inhibitors was significantly protective (hazard ratio, 0.358; 95% confidence interval, 0.142-0.902; P = .029).
Retrospective analysis.
Subsequent NMSCs are very frequent in LTRs, and conversion from a calcineurin inhibitor-based immunosuppressive regimen to a mammalian target of rapamycin inhibitor/antimetabolite-based immunosuppressive regimen can reduce subsequent NMSCs.
非黑色素瘤皮肤癌（NMSC）是实体器官移植受者中最常见的癌症，其后续肿瘤发生率较高。
描述一组接受肝移植（LTR）后随访时间较长的大型肝移植受者（LTR）中随后发生的 NMSC，并分析影响其发生的因素，包括免疫抑制方案。
共纳入 96 例（76 例男性）有鳞状细胞癌、基底细胞癌或 Bowen 病个人移植后病史的 LTR，肝移植后中位随访时间为 12.4 年（范围，1.5-27.8 年）。
首次发生 NMSC 后的中位随访时间为 6.4 年（范围，0.17-22.1 年）。共有 52 例患者（53.1%）发生了 141 例随后的 NMSC，基底细胞癌与鳞状细胞癌的比例为 1.8:1。第 1 年、第 2 年、第 5 年、第 10 年和第 15 年发生第 2 次 NMSC 的累积风险分别为 13.7%、28.4%、49.4%、65.7%和 88.4%。多因素分析发现，皮肤光型 I 或 II（而非 III 或 IV）是发生第 2 次 NMSC 的显著危险因素（风险比，2.556；95%置信区间，1.45-4.48；P=0.001），而停用钙调磷酸酶抑制剂具有显著保护作用（风险比，0.358；95%置信区间，0.142-0.902；P=0.029）。
回顾性分析。
LTR 中随后发生的 NMSC 非常常见，将基于钙调磷酸酶抑制剂的免疫抑制方案转换为哺乳动物雷帕霉素靶蛋白抑制剂/抗代谢物为基础的免疫抑制方案可减少随后发生的 NMSC。
