Department of Dermatology, University of Pennsylvania, Philadelphia.
Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston.
JAMA Dermatol. 2021 Dec 1;157(12):1447-1455. doi: 10.1001/jamadermatol.2021.4148.
There are limited reports on the risks of multiple primary skin cancers in organ transplant recipients (OTRs).
To determine the risks over time and risk factors for OTRs developing (1) any skin cancer posttransplant, (2) a subsequent skin cancer after the first posttransplant skin cancer in the data sets used in the study, and (3) 10 or more skin cancers.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data from Optum deidentified electronic health record data set (7.7 million patients) and Truven Health MarketScan insurance claims data set (161 million patients) from 2007 to 2017. Skin cancers were identified using diagnosis plus treatment codes for basal cell carcinoma, squamous cell carcinoma, and melanoma; OTRs were identified using 4 or more diagnosis codes for organ transplant. Data analysis took place from January 1, 2007, to December 31, 2017.
Cumulative risks of (1) any skin cancer treatment posttransplant, (2) a subsequent skin cancer treatment after the first posttransplant skin cancer treatment in our data, and (3) 10 or more skin cancer treatments in OTRs. A Wei-Lin-Weissfeld marginal model was used to evaluate risk factors for any skin cancer.
A total of 7390 OTRs in Optum and 133 651 in MarketScan were identified, 4.5% and 13.3% of which had had at least 1 skin cancer treatment, respectively. At 2 years after the initial posttransplant skin cancer in the data sets, OTRs had a 44.0% to 57.0% risk of a subsequent skin cancer treatment and a 3.7% to 6.6% risk of having 10 or more skin cancer treatments. Statistically significant risk factors for any skin cancer included age, history of skin cancer, and history of actinic keratosis in both data sets, and male sex and thoracic transplant in MarketScan.
In this retrospective cohort study, approximately half of the OTRs who developed at least 1 posttransplant skin cancer developed a subsequent skin cancer within 2 years, and approximately 1 in 20 developed 10 or more skin cancers. Identifying OTRs at highest risk for multiple primary skin cancers may help target strategies for prevention and early detection.
有关器官移植受者（OTR）发生多种原发性皮肤癌的风险的报告有限。
确定 OTR 随时间推移发生以下情况的风险：（1）移植后任何皮肤癌，（2）在本研究中使用的数据集中首次移植后皮肤癌后的后续皮肤癌，以及（3）10 个或更多皮肤癌。
设计、地点和参与者：这项回顾性队列研究使用了 2007 年至 2017 年期间 Optum 去识别电子健康记录数据集（770 万患者）和 Truven Health MarketScan 保险索赔数据集（1.61 亿患者）的数据。基底细胞癌、鳞状细胞癌和黑色素瘤的诊断加治疗代码用于识别皮肤癌；4 个或更多器官移植诊断代码用于识别 OTR。数据分析于 2007 年 1 月 1 日至 2017 年 12 月 31 日进行。
OTR 中（1）移植后任何皮肤癌治疗、（2）我们数据中首次移植后皮肤癌治疗后的后续皮肤癌治疗，以及（3）10 个或更多皮肤癌治疗的累积风险。使用 Wei-Lin-Weissfeld 边缘模型评估任何皮肤癌的风险因素。
在 Optum 中确定了 7390 名 OTR 和 133651 名 MarketScan 中的 OTR，其中分别有 4.5%和 13.3%的患者至少接受过 1 次皮肤癌治疗。在数据集的初始移植后皮肤癌后 2 年内，OTR 发生后续皮肤癌治疗的风险为 44.0%至 57.0%，发生 10 个或更多皮肤癌治疗的风险为 3.7%至 6.6%。两个数据集均有统计学意义的任何皮肤癌风险因素包括年龄、皮肤癌病史和光化性角化病病史，MarketScan 中的男性和胸部移植。
在这项回顾性队列研究中，约一半发生至少 1 次移植后皮肤癌的 OTR 在 2 年内发生了后续皮肤癌，约 1/20 发生了 10 个或更多皮肤癌。确定发生多种原发性皮肤癌风险最高的 OTR 可能有助于针对预防和早期发现制定策略。
