Section of Gastroenterology, Corporal Michel J. Crescenz VA Medical Center, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Clin Gastroenterol Hepatol. 2019 Oct;17(11):2262-2268. doi: 10.1016/j.cgh.2019.03.005. Epub 2019 Mar 7.
BACKGROUND & AIMS: Treatment with thiopurines is associated with an increased risk of squamous cell carcinoma of the skin (SCC) in patients with inflammatory bowel diseases (IBD). We studied outcomes of patients with IBD who developed SCC while receiving thiopurine therapy.
We conducted a retrospective cohort study of 54,919 patients with IBD followed in the nationwide Veterans Affairs Healthcare System from January 1, 2000, through May 23, 2018. From this cohort, we created a sub-cohort of patients with an incident diagnosis of SCC, confirmed by review of patients' medical records; we identified those who had received treatment with thiopurines (exposed group) vs those treated with mesalamine and no prior exposure to thiopurines or tumor necrosis factor antagonists (unexposed group). The primary outcome was death associated with SCC (SCC mortality). We collected data on baseline demographic features, exposure to ultraviolet light, Charlson comorbidity index, smoking status, and environmental exposures. Follow up began at the time of incident SCC diagnosis and ended at death or last recorded date in the health system. Cause-specific hazard models were used to estimate the adjusted and unadjusted hazard ratio (HRs), with 95% CIs, for SCC mortality.
We identified 467 patients with incident SCC and included 449 patients (161 exposed and 288 unexposed) in our final analysis. Eleven patients from complications of SCC (8 in the exposed group and 3 in the unexposed group). The estimated 5- and 10-year cumulative mortality values were 2.9% and 2.9% in the exposed group and 0.4% and 0.9% in the unexposed group, respectively. The unadjusted and adjusted cause-specific HRs for SCC mortality associated with exposure were 7.0 (95% CI, 1.8-28.0; P = .006) and 8.0 (95% CI, 2.0-32.8; P = .004), respectively.
Although the cause-specific mortality is relatively low, patients with IBD exposed to thiopurines who develop SCC have an increased risk of SCC-associated death compared to patients exposed to only mesalamine.
在炎症性肠病（IBD）患者中，使用硫嘌呤治疗与皮肤鳞状细胞癌（SCC）的风险增加有关。我们研究了在接受硫嘌呤治疗的同时发生 SCC 的 IBD 患者的结局。
我们对 2000 年 1 月 1 日至 2018 年 5 月 23 日期间在全国退伍军人事务部医疗保健系统中接受治疗的 54919 例 IBD 患者进行了回顾性队列研究。从该队列中，我们创建了一个 SCC 确诊的亚队列，通过回顾患者的病历进行确认；我们确定了接受硫嘌呤治疗（暴露组）的患者和接受美沙拉嗪治疗且无硫嘌呤或肿瘤坏死因子拮抗剂暴露史的患者（未暴露组）。主要结局是与 SCC 相关的死亡（SCC 死亡率）。我们收集了基线人口统计学特征、紫外线暴露、Charlson 合并症指数、吸烟状况和环境暴露的数据。随访从 SCC 确诊开始，截止至患者死亡或在医疗系统中最后一次记录日期。使用特定原因风险模型估计 SCC 死亡率的调整和未调整危险比（HR）及其 95%置信区间（CI）。
我们确定了 467 例 SCC 确诊患者，其中 449 例（暴露组 161 例，未暴露组 288 例）纳入最终分析。11 例患者因 SCC 并发症（暴露组 8 例，未暴露组 3 例）死亡。暴露组患者的 5 年和 10 年累积死亡率分别为 2.9%和 2.9%，未暴露组患者的相应死亡率分别为 0.4%和 0.9%。未调整和调整后的 SCC 死亡率与暴露相关的特定原因 HR 分别为 7.0（95%CI，1.8-28.0；P =.006）和 8.0（95%CI，2.0-32.8；P =.004）。
尽管特定原因死亡率相对较低，但与仅接受美沙拉嗪治疗的患者相比，接受硫嘌呤治疗且发生 SCC 的 IBD 患者 SCC 相关死亡的风险增加。
