Kraemer K H, DiGiovanna J J, Moshell A N, Tarone R E, Peck G L
Laboratory of Molecular Carcinogenesis, National Cancer Institute, Bethesda, Md 20892.
N Engl J Med. 1988 Jun 23;318(25):1633-7. doi: 10.1056/NEJM198806233182501.
To confirm reports that skin cancer can be prevented with retinoids, we conducted a three-year controlled prospective study of oral isotretinoin (also called 13-cis retinoic acid) in five patients with xeroderma pigmentosum who had a history of multiple cutaneous basal-cell or squamous-cell carcinomas. Patients were treated with isotretinoin at a dosage of 2 mg per kilogram of body weight per day for two years and then followed for an additional year, without the drug. Before, during, and after treatment, biopsies of all suspicious lesions were performed, and skin cancers were surgically removed. The patients had a total of 121 tumors (mean, 24; range, 8 to 43) in the two-year interval before treatment. During two years of treatment with isotretinoin, there were 25 tumors (mean, 5; range, 3 to 9), with an average reduction in skin cancers of 63 percent (P = 0.019). After the drug was discontinued, the tumor frequency increased a mean of 8.5-fold (range, 2- to 19-fold) over the frequency during treatment (P = 0.007). Although all patients experienced mucocutaneous toxic effects, and triglyceride, liver-function, or skeletal abnormalities developed in some, high-dose oral isotretinoin was effective in the chemoprophylaxis of skin cancers in patients with xeroderma pigmentosum.
为证实维甲酸可预防皮肤癌的报道，我们对5例有多发皮肤基底细胞癌或鳞状细胞癌病史的着色性干皮病患者进行了为期三年的口服异维甲酸（也称为13 - 顺式维甲酸）对照前瞻性研究。患者每天按每公斤体重2毫克的剂量服用异维甲酸，持续两年，然后停药再随访一年。在治疗前、治疗期间和治疗后，对所有可疑病变进行活检，并手术切除皮肤癌。患者在治疗前的两年期间共有121个肿瘤（平均24个；范围8至43个）。在服用异维甲酸治疗的两年中，有25个肿瘤（平均5个；范围3至9个），皮肤癌平均减少63%（P = 0.019）。停药后，肿瘤发生率比治疗期间平均增加8.5倍（范围2至19倍）（P = 0.007）。尽管所有患者都出现了皮肤黏膜毒性反应，部分患者还出现了甘油三酯、肝功能或骨骼异常，但高剂量口服异维甲酸对预防着色性干皮病患者的皮肤癌有效。
