Department of Dermatology, Erasmus Medical Center, Rotterdam, the Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands.
JAMA Dermatol. 2020 Sep 1;156(9):973-981. doi: 10.1001/jamadermatol.2020.1988.
The incidence rates of keratinocyte cancer are increasing globally; however, the incidence rates of cutaneous squamous cell carcinoma (cSCC) in situ and the risk of developing subsequent invasive cSCC remain unknown.
To estimate annual population-based age-standardized incidence rates of histopathologically confirmed cSCC in situ stratified by sex, age, and body site and to assess the risk of developing invasive cSCC among patients with cSCC in situ compared with the general population.
DESIGN, SETTING, AND PARTICIPANTS: This nationwide epidemiological population-based cohort study used cancer registry data to identify all patients with a first incident of histopathologically confirmed cSCC in situ between January 1, 1989, and December 31, 2017. In addition, all patients with cSCC in situ who subsequently had a first incident of invasive cSCC were identified up to June 11, 2019. Data were analyzed between March 18 and November 12, 2019.
Age-standardized incidence rates per year for cSCC in situ, standardized to the 2013 edition of the European Standard Population, were calculated by sex, age, and body site. Cumulative risks, standardized incidence ratios, and absolute excess risks were calculated to assess the risk of invasive cSCC in patients with cSCC in situ compared with the general population.
In this population-based cohort study of 88 754 patients with a first incident of cSCC in situ between January 1, 1989, and December 31, 2017, 58.8% were women; the median age was 75 years (interquartile range [IQR], 67-82 years) for women and 73 years (IQR, 65-80 years) for men. Increasing incidence rates were observed, with the highest incidence rates in 2017 among women in general (71.7 cases per 100 000 person-years) and among men 80 years and older (540.9 cases per 100 000 person-years). The most common body site among women was the face (15.9 cases per 100 000 person-years) and among men was the scalp and/or neck (12.3 cases per 100 000 person-years). After 5 years of follow-up, among patients with cSCC in situ, the cumulative risk of developing an invasive cSCC at any anatomic location was 11.7% (95% CI, 11.6%-11.9%) in men and 6.9% (95% CI, 6.8%-7.0%) in women (P < .001). The standardized incidence ratio was highest in the first year of follow-up among both men (16.6; 95% CI, 15.7-17.5) and women (15.1; 95% CI, 14.2-16.1).
This study reports the first nationwide incidence rates of cSCC in situ to date. The increasing incidence rates of cSCC in situ and the high risk of developing invasive cSCC among patients with cSCC in situ may increase the health care burden associated with precursors of keratinocyte cancer and highlight the need to include cutaneous skin cancer precursor lesions when exploring policies to address skin cancer care.
全球范围内，角蛋白细胞癌的发病率正在上升；然而，原位皮肤鳞状细胞癌（cSCC）的发病率以及发展为后续侵袭性 cSCC 的风险仍不清楚。
评估按性别、年龄和身体部位分层的经组织病理学证实的 cSCC 原位的年度人群标准化发病率，并评估与普通人群相比，cSCC 原位患者发展为侵袭性 cSCC 的风险。
设计、设置和参与者：这项全国性的基于人群的流行病学队列研究使用癌症登记数据确定了 1989 年 1 月 1 日至 2017 年 12 月 31 日期间首次确诊为经组织病理学证实的 cSCC 原位的所有患者。此外，还确定了所有随后首次确诊为侵袭性 cSCC 的 cSCC 原位患者。数据于 2019 年 3 月 18 日至 11 月 12 日之间进行分析。
通过性别、年龄和身体部位，按 2013 年版欧洲标准人群对 cSCC 原位的每年标准化发病率进行计算。计算累积风险、标准化发病比和绝对超额风险，以评估与普通人群相比，cSCC 原位患者发展为侵袭性 cSCC 的风险。
在这项基于人群的队列研究中，纳入了 1989 年 1 月 1 日至 2017 年 12 月 31 日期间首次确诊为 cSCC 原位的 88754 例患者，其中 58.8%为女性；女性的中位年龄为 75 岁（四分位距[IQR]，67-82 岁），男性为 73 岁（IQR，65-80 岁）。发病率呈上升趋势，2017 年女性的发病率最高（71.7 例/10 万人口年），80 岁及以上男性的发病率最高（540.9 例/10 万人口年）。女性最常见的发病部位是面部（15.9 例/10 万人口年），男性是头皮和/或颈部（12.3 例/10 万人口年）。在 5 年的随访中，cSCC 原位患者在任何解剖部位发展为侵袭性 cSCC 的累积风险在男性中为 11.7%（95%CI，11.6%-11.9%），在女性中为 6.9%（95%CI，6.8%-7.0%）（P<.001）。在男性（16.6；95%CI，15.7-17.5）和女性（15.1；95%CI，14.2-16.1）中，风险比在随访的第一年最高。
本研究报告了迄今为止首个全国性的 cSCC 原位发病率。cSCC 原位的发病率不断上升，以及 cSCC 原位患者发展为侵袭性 cSCC 的高风险可能会增加与角蛋白细胞癌前体相关的医疗保健负担，并强调在探索解决皮肤癌护理的政策时，需要将皮肤癌前病变纳入考虑范围。
