Department of Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
Northern Sydney Clinical School, The University of Sydney, Sydney, NSW, Australia.
Transplantation. 2019 Jun;103(6):1206-1215. doi: 10.1097/TP.0000000000002641.
Organ transplant recipients are at high risk of developing skin cancer. The benefits and harms of interventions to prevent nonmelanoma skin cancer in solid organ transplant recipients have not been summarized.
We searched MEDLINE, Embase, and CENTRAL through April 2018. Risk of bias was assessed using the Cochrane tool, and evidence certainty was evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation process. Prespecified outcomes were nonmelanoma skin cancer, clearance and prevention of keratotic skin lesions, and intervention-specific adverse events.
Ninety-two trials (20 012 participants) were included. The evaluated treatments were cancer-specific interventions (acitretin, imiquimod, photodynamic therapy, nicotinamide, topical diclofenac, and selenium) and immunosuppression regimes (azathioprine, mycophenolate mofetil, calcineurin inhibitors, mammalian target of rapamycin [mTOR] inhibitors, belatacept, induction agents, and withdrawal of calcineurin inhibitors or corticosteroids). Effects on nonmelanoma skin cancer were uncertain for photodynamic therapy (3 trials, 93 participants, risk ratio [RR] 1.42 [95% confidence interval (CI), 0.65-3.11]; low certainty evidence), nicotinamide (2 trials, 60 participants), acitretin (2 trials, 61 participants), and imiquimod (1 trial, 20 participants) compared to control. mTOR inhibitors probably reduced skin cancer compared to calcineurin inhibitors (12 trials, 2225 participants, RR 0.62 [95% CI, 0.45-0.85]; moderate certainty evidence). Photodynamic therapy may cause pain at the treatment site (4 trials, 95 patients, RR 17.09 [95% CI, 4.22-69.26]; low certainty evidence).
There is limited evidence for the efficacy and safety of specific treatments to prevent nonmelanoma skin cancers among solid organ transplant recipients.
器官移植受者患皮肤癌的风险很高。尚未总结干预措施预防实体器官移植受者非黑色素瘤皮肤癌的获益和危害。
我们通过 2018 年 4 月检索了 MEDLINE、Embase 和 CENTRAL。使用 Cochrane 工具评估偏倚风险，使用推荐评估、制定与评价（Grades of Recommendation, Assessment, Development, and Evaluation，GRADE）过程评估证据确定性。预设结局为非黑色素瘤皮肤癌、角化病损的清除和预防以及干预特异性不良事件。
纳入了 92 项试验（20012 名参与者）。评估的治疗方法包括癌症特异性干预（阿维 A、咪喹莫特、光动力疗法、烟酰胺、外用双氯芬酸和硒）和免疫抑制方案（硫唑嘌呤、霉酚酸酯、钙调神经磷酸酶抑制剂、雷帕霉素靶蛋白 [mTOR] 抑制剂、巴利昔单抗、诱导剂以及停用钙调神经磷酸酶抑制剂或皮质类固醇）。光动力疗法（3 项试验，93 名参与者，风险比 [RR] 1.42 [95%置信区间（CI），0.65-3.11]；低确定性证据）、烟酰胺（2 项试验，60 名参与者）、阿维 A（2 项试验，61 名参与者）和咪喹莫特（1 项试验，20 名参与者）与对照组相比，对非黑色素瘤皮肤癌的影响不确定。与钙调神经磷酸酶抑制剂相比，mTOR 抑制剂可能降低皮肤癌风险（12 项试验，2225 名参与者，RR 0.62 [95% CI，0.45-0.85]；中等确定性证据）。光动力疗法可能会引起治疗部位疼痛（4 项试验，95 名患者，RR 17.09 [95% CI，4.22-69.26]；低确定性证据）。
对于实体器官移植受者预防非黑色素瘤皮肤癌的特定治疗方法，疗效和安全性的证据有限。
