Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Dermatology, Yonsei University College of Medicine, Seoul, Korea.
JAMA Dermatol. 2020 May 1;156(5):529-537. doi: 10.1001/jamadermatol.2020.0218.
Narrowband UV-B (NBUVB) phototherapy has been the mainstay in the treatment of vitiligo, but its long-term safety in terms of photocarcinogenesis has not been established.
To investigate the risks of skin cancer and precancerous lesions among patients with vitiligo undergoing NBUVB phototherapy, based on the number of NBUVB phototherapy sessions.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide population-based retrospective cohort study enrolled 60 321 patients with vitiligo 20 years or older between January 1, 2007, and December 31, 2017. Patients and outcomes were identified through nationwide cohort data from the Korean national health insurance claims database, and frequency matching by age and sex was performed.
The number of phototherapy sessions each patient received between 2008 and 2017. Patients were classified into 5 groups according to the number of phototherapy sessions (0 sessions, 20 105 patients; 1-49 sessions, 20 106 patients; 50-99 sessions, 9702 patients; 100-199 sessions, 6226 patients; and ≥200 sessions, 4182 patients). We also identifed patients who underwent at least 500 phototherapy sessions (717 patients).
Primary outcomes were the development of actinic keratosis, Bowen disease, nonmelanoma skin cancer, or melanoma after enrollment.
Among the 60 321 patients with vitiligo in this study (33 617 women; mean [SD] age, 50.2 [14.9] years), the risks of Bowen disease (<50 sessions of phototherapy: hazard ratio [HR], 0.289 [95% CI, 0.060-1.392]; 50-99 sessions: HR, 0.603 [95% CI, 0.125-2.904]; 100-199 sessions: HR, 1.273 [95% CI, 0.329-4.924]; ≥200 sessions: HR, 1.021 [95% CI, 0.212-4.919]), nonmelanoma skin cancer (<50 sessions: HR, 0.914 [95% CI, 0.533-1.567]; 50-99 sessions: HR, 0.765 [95% CI, 0.372-1.576]; 100-199 sessions: HR, 0.960 [95% CI, 0.453-2.034]; ≥200 sessions: HR, 0.905 [95% CI, 0.395-2.073]), and melanoma (<50 sessions: HR, 0.660 [95% CI, 0.286-1.526]; 50-99 sessions: HR, 0.907 [95% CI, 0.348-2.362]; 100-199 sessions: HR, 0.648 [95% CI, 0.186-2.255]; ≥200 sessions: HR, 0.539 [95% CI, 0.122-2.374]) did not increase after phototherapy. The risk of actinic keratosis increased significantly for those who had undergone 200 or more NBUVB phototherapy sessions (HR, 2.269 [95% CI, 1.530-3.365]). A total of 717 patients with vitiligo underwent at least 500 sessions of NBUVB phototherapy; their risks of nonmelanoma skin cancer and melanoma were no greater than those of the patients who did not undergo NBUVB phototherapy (nonmelanoma skin cancer: HR, 0.563 [95% CI, 0.076-4.142]; melanoma: HR, not applicable).
Our results suggest that long-term NBUVB phototherapy is not associated with an increased risk of skin cancer in patients with vitiligo and that NBUVB phototherapy may be considered a safe treatment.
窄谱 UV-B（NBUVB）光疗一直是治疗白癜风的主要方法，但它在光致癌方面的长期安全性尚未确定。
基于 NBUVB 光疗次数，调查白癜风患者接受 NBUVB 光疗后皮肤癌和癌前病变的风险。
设计、设置和参与者：这项全国范围内基于人群的回顾性队列研究纳入了 2007 年 1 月 1 日至 2017 年 12 月 31 日期间年龄在 20 岁或以上的 60321 名白癜风患者。通过全国范围内的韩国国民健康保险索赔数据库中的队列数据和按年龄和性别进行的频率匹配来确定患者和结局。
每位患者在 2008 年至 2017 年之间接受的光疗次数。患者根据光疗次数分为 5 组（0 次，20105 例；1-49 次，20106 例；50-99 次，9702 例；100-199 次，6226 例；≥200 次，4182 例）。我们还确定了接受至少 500 次光疗的患者（717 例）。
主要结局是在入组后发生光化性角化病、鲍恩病、非黑色素瘤皮肤癌或黑色素瘤。
在这项研究的 60321 名白癜风患者中（33617 名女性；平均[SD]年龄，50.2[14.9]岁），鲍恩病（光疗次数<50 次：风险比[HR]，0.289[95%CI，0.060-1.392]；50-99 次：HR，0.603[95%CI，0.125-2.904]；100-199 次：HR，1.273[95%CI，0.329-4.924]；≥200 次：HR，1.021[95%CI，0.212-4.919]）、非黑色素瘤皮肤癌（光疗次数<50 次：HR，0.914[95%CI，0.533-1.567]；50-99 次：HR，0.765[95%CI，0.372-1.576]；100-199 次：HR，0.960[95%CI，0.453-2.034]；≥200 次：HR，0.905[95%CI，0.395-2.073]）和黑色素瘤（光疗次数<50 次：HR，0.660[95%CI，0.286-1.526]；50-99 次：HR，0.907[95%CI，0.348-2.362]；100-199 次：HR，0.648[95%CI，0.186-2.255]；≥200 次：HR，0.539[95%CI，0.122-2.374]）的风险在光疗后并未增加。接受 200 次或更多 NBUVB 光疗的患者发生光化性角化病的风险显著增加（HR，2.269[95%CI，1.530-3.365]）。717 名白癜风患者接受了至少 500 次 NBUVB 光疗；他们发生非黑色素瘤皮肤癌和黑色素瘤的风险并不高于未接受 NBUVB 光疗的患者（非黑色素瘤皮肤癌：HR，0.563[95%CI，0.076-4.142]；黑色素瘤：HR，不适用）。
我们的结果表明，长期接受 NBUVB 光疗与白癜风患者皮肤癌风险增加无关，并且 NBUVB 光疗可能是一种安全的治疗方法。
