Department of Dermatology, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia.
St Vincent's Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
JAMA Dermatol. 2019 Jun 1;155(6):716-719. doi: 10.1001/jamadermatol.2018.4789.
There is limited research examining the incidence of nonmelanoma skin cancer (NMSC) in heart and lung transplant recipients in Australia.
To determine the frequency of and risk factors for NMSC in a cohort of Australian heart and lung transplant recipients.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at an Australian tertiary center where heart and lung transplants are performed between March 21 and December 14, 2016. A consecutive sample of 94 patients who underwent heart and/or lung transplant presenting for outpatient dermatologic review were evaluated. Data analysis was conducted between April 18 and October 30, 2017.
Risk factors examined for association with posttransplantation NMSC included age at the time of transplantation, sex, skin phenotype, UV radiation exposure, history of allograft rejection, history of smoking, history of skin cancer prior to transplant, and transplant type.
The primary outcome measure was the occurrence of posttransplantation NMSC. The probabilities of developing NMSC in general, and squamous cell carcinoma and basal cell carcinoma specifically, were separately summarized based on Kaplan-Meier analysis. Association of risk factors with development of NMSC was examined using univariable and multivariable Cox proportional hazards regression analysis.
Of the 94 study participants, 58 (62%) were men; median age at transplantation was 51.9 years (range, 15.1-69.7 years). There were 801 posttransplantation skin cancers in 57 (61%) of the patients who underwent heart and/or lung transplant. The probabilities for NMSC were 41% (95% CI, 31%-53%) at 5 years and 67% (95% CI, 55%-78%) at 10 years; for basal cell carcinoma, 27% (95% CI, 18%-38%) at 5 years and 53% (95% CI, 40%-67%) at 10 years; and for squamous cell carcinoma, 33% (95% CI, 24%-45%) at 5 years and 62% (95% CI, 50%-74%) at 10 years. On multivariable analysis, older age at transplantation was associated with the development of NMSC (hazard ratio [HR], 1.07/1 year; 95% CI, 1.04-1.10; P < .001) and history of pretransplant skin cancer was associated with development of basal cell carcinoma (HR, 4.56; 95% CI, 1.67-12.42; P = .003). A Fitzpatrick skin type III to VI was associated with a decreased risk of NMSC (HR, 0.42; 95% CI, 0.24-0.74; P = .003). Sex, transplanted organ, UV radiation exposure, and history of allograft rejection were not associated with an increased risk of skin cancer.
In this study of Australian heart and lung transplant recipients, there was a probable high frequency of NMSC. Routine dermatologic surveillance at frequent intervals is advised for similar populations.
在澳大利亚，有关心脏和肺移植受者中非黑色素瘤皮肤癌（NMSC）发病率的研究有限。
确定澳大利亚心脏和肺移植受者中非黑色素瘤皮肤癌的发生频率和危险因素。
设计、地点和参与者：这是一项回顾性队列研究，在澳大利亚一家三级中心进行，该中心于 2016 年 3 月 21 日至 12 月 14 日进行心脏和/或肺移植。评估了 94 名连续接受心脏和/或肺移植并进行门诊皮肤科检查的患者。数据分析于 2017 年 4 月 18 日至 10 月 30 日进行。
为了与移植后 NMSC 的发生相关，检查了包括移植时年龄、性别、皮肤表型、紫外线辐射暴露、同种异体移植物排斥史、吸烟史、移植前皮肤癌史和移植类型在内的危险因素。
主要结局指标为移植后 NMSC 的发生。基于 Kaplan-Meier 分析，分别总结了一般情况下 NMSC 的发生概率，以及特定情况下鳞状细胞癌和基底细胞癌的发生概率。使用单变量和多变量 Cox 比例风险回归分析，研究了危险因素与 NMSC 发展的关系。
在 94 名研究参与者中，58 名（62%）为男性；移植时的中位年龄为 51.9 岁（范围，15.1-69.7 岁）。在接受心脏和/或肺移植的患者中，有 57 例（61%）患者发生了 801 例移植后皮肤癌。NMSC 的概率为 5 年时 41%（95%CI，31%-53%），10 年时 67%（95%CI，55%-78%）；基底细胞癌的概率为 5 年时 27%（95%CI，18%-38%），10 年时 53%（95%CI，40%-67%）；鳞状细胞癌的概率为 5 年时 33%（95%CI，24%-45%），10 年时 62%（95%CI，50%-74%）。多变量分析显示，移植时年龄较大与 NMSC 的发生相关（风险比[HR]，1.07/1 年；95%CI，1.04-1.10；P<0.001），移植前皮肤癌史与基底细胞癌的发生相关（HR，4.56；95%CI，1.67-12.42；P=0.003）。Fitzpatrick 皮肤类型 III 至 VI 与 NMSC 的风险降低相关（HR，0.42；95%CI，0.24-0.74；P=0.003）。性别、移植器官、紫外线辐射暴露和同种异体移植物排斥史与皮肤癌风险增加无关。
在这项对澳大利亚心脏和肺移植受者的研究中，NMSC 的发生频率可能很高。类似人群建议定期进行皮肤科监测。
