Department of Dermatology, Chonnam National University Medical School, Gwangju, Korea.
Department of Dermatology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Eur Acad Dermatol Venereol. 2020 Apr;34(4):746-753. doi: 10.1111/jdv.15936. Epub 2019 Nov 26.
Non-melanoma skin cancers (NMSCs) are the most common cancers in the world, but the risk of internal malignancy in patients with NMSC has not been well investigated.
We aimed to assess the risk of internal malignancy in patients with NMSC compared with controls without NMSC in Korean population.
This nationwide cohort study, compared 27 259 NMSC patients with 54 518 matched controls without NMSC, 40 years or older using the data from Korea Health Insurance Review and Assessment Service from 2007 to 2016. The first 2 years were washout period, and we followed the patients for 8 years to observe the development of any internal malignancies after a diagnosis of NMSC. The Cox proportional hazard model was used to determine the hazard ratios (HRs) for developing internal malignancies.
The overall risk of internal malignancies at all sites was 2727.7 and 1392.4 per 100 000 person-years for the patients with NMSC and controls, respectively. The risk was significantly higher in the patients with NMSC (HR 1.866, 95% confidence interval [CI] 1.768-1.970). Bone cancer showed the highest risk (HR 12.745, 95% CI 6.288-25.834), followed by nasal cavity and larynx (HR 10.279, 95% CI 6.178-7.103), oral cavity and pharynx (HR 10.211, 95% CI 7.375-14.137), anus and anal canal (HR 8.147, 95% CI 3.893-17.051) and cervical (HR 5.900, 95% CI 3.694-9.423) cancers with risks greater than fivefold higher in NMSC patients compared with the controls. The risks of cancers of the thorax, oesophagus, breast, lung, stomach, thyroid gland and non-Hodgkin's lymphoma were also statistically higher in the patients with NMSC. In contrast, the risks of cancers of the colon and rectum were found to be significantly decreased in the patients with NMSC (HR 0.765, 95% CI 0.657-0.890).
Patients with NMSC require careful screening and follow-up for internal malignancy.
非黑色素瘤皮肤癌（NMSC）是世界上最常见的癌症，但 NMSC 患者发生内部恶性肿瘤的风险尚未得到很好的研究。
我们旨在评估与无 NMSC 的对照相比，韩国人群中 NMSC 患者发生内部恶性肿瘤的风险。
这项全国性队列研究比较了 2007 年至 2016 年期间，来自韩国健康保险审查和评估服务的数据，27259 名 NMSC 患者与 54518 名年龄在 40 岁或以上、无 NMSC 的匹配对照者。前 2 年为洗脱期，我们对患者进行了 8 年的随访，以观察 NMSC 诊断后任何内部恶性肿瘤的发展情况。使用 Cox 比例风险模型确定发生内部恶性肿瘤的风险比（HR）。
NMSC 患者和对照组的所有部位内部恶性肿瘤的总体风险分别为每 100000 人年 2727.7 和 1392.4 例。NMSC 患者的风险显著更高（HR 1.866，95%置信区间[CI] 1.768-1.970）。骨癌的风险最高（HR 12.745，95%CI 6.288-25.834），其次是鼻腔和喉（HR 10.279，95%CI 6.178-7.103）、口腔和咽（HR 10.211，95%CI 7.375-14.137）、肛门和肛管（HR 8.147，95%CI 3.893-17.051）和宫颈（HR 5.900，95%CI 3.694-9.423）癌症，NMSC 患者的风险高于对照组五倍以上。NMSC 患者的胸部、食道、乳房、肺、胃、甲状腺和非霍奇金淋巴瘤的癌症风险也明显更高。相比之下，NMSC 患者的结直肠癌风险显著降低（HR 0.765，95%CI 0.657-0.890）。
NMSC 患者需要仔细筛查和随访内部恶性肿瘤。
