Department of Dermatology and Venereology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark.
Department of Dermatology and Allergy, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
Dermatology. 2023;239(3):393-402. doi: 10.1159/000529369. Epub 2023 Feb 2.
Solid organ transplant recipients (SOTRs) are at increased risk of skin cancer and suffer from greater disease-specific morbidity and mortality. To risk stratify the expanding SOTR population for more targeted skin cancer screening, a detailed understanding of risk factors is needed. Using combined clinical and pathological data to capture prevalence of actinic keratosis (AK) and skin cancer, this study aimed to identify risk factors of skin cancer development in a Danish SOTR cohort.
The trial comprised a retrospective cohort study of patients attending organ transplant clinics at the dermatological departments of Bispebjerg and Gentofte Hospitals in Copenhagen, Denmark, between 2009 and 2021. In addition to pathology records, AK prevalence was determined by review of electronic medical records (EMRs) of SOTR visits which specifically included descriptions of clinical AK. Prevalence of skin cancer, here defined as basal cell carcinoma (BCC), squamous cell carcinoma (SCC) (invasive or in situ), or melanoma (invasive or in situ), was determined by EMR and pathology code review. Additional data extracted from EMRs included age, sex, Fitzpatrick skin type, transplantation date and type, and immunosuppressive therapy. The effect of risk factors on skin cancer was calculated by Cox proportional hazards regression.
A total of 822 SOTRs were included with a mean follow-up duration of 10.8 years (SD 2.4 years). A skin dysplasia diagnosis was identified in 30% (n = 250) of the population, consisting of either AK (22%; n = 177), skin cancer (23%; n = 186) or both (14%; n = 113). An AK diagnosis predicted both SCC (odds ratio [OR]: 31.5 [95% CI: 9.8-100.6], p < 0.0001) and BCC development (OR: 2.3 [95% CI: 1.6-3.3], p < 0.0001), with AKs diagnosed an average 3.1 years before the first SCC (p < 0.0001). Correspondingly, while the risk of SCC in SOTRs without AK was 1.4% 25 years after transplantation, SOTRs with AKs had a 23% SCC risk only 10 years posttransplant. Other identified risk factors included Fitzpatrick skin type I (BCC: OR: 2.4 [95% CI: 1.2-5.0], p = 0.018; SCC: 3.2 [95% CI: 1.2-8.2], p = 0.016) and transplantation duration >15 years (BCC: OR: 1.8 [95% CI: 1.2-2.7], p = 0.007). No significant association between skin cancer development and sex or immunosuppressive regimen was shown.
Keratinocyte carcinoma is strongly associated with an AK diagnosis in SOTRS and should prompt intensified skin cancer screening in affected individuals.
实体器官移植受者（SOTR）患皮肤癌的风险增加，并且疾病特异性发病率和死亡率更高。为了对不断扩大的 SOTR 人群进行风险分层，以便更有针对性地进行皮肤癌筛查，需要详细了解风险因素。本研究使用临床和病理综合数据来捕捉光化性角化病（AK）和皮肤癌的患病率，旨在确定丹麦 SOTR 队列中皮肤癌发展的风险因素。
该试验包括对丹麦哥本哈根比斯加比约格和根托夫特医院皮肤科门诊的 SOTR 患者进行的回顾性队列研究，时间为 2009 年至 2021 年。除病理记录外，还通过审查 SOTR 就诊的电子病历（EMR）来确定 AK 的患病率，这些病历专门包括 AK 的临床描述。通过 EMR 和病理代码审查确定皮肤癌（定义为基底细胞癌（BCC）、鳞状细胞癌（SCC）（浸润性或原位）或黑色素瘤（浸润性或原位）的患病率。从 EMR 中提取的其他数据包括年龄、性别、Fitzpatrick 皮肤类型、移植日期和类型以及免疫抑制治疗。使用 Cox 比例风险回归计算风险因素对皮肤癌的影响。
共纳入 822 名 SOTR，平均随访时间为 10.8 年（SD 2.4 年）。人群中有 30%（n=250）被诊断为皮肤发育不良，包括 AK（22%，n=177）、皮肤癌（23%，n=186）或两者兼有（14%，n=113）。AK 诊断预测了 SCC（比值比[OR]：31.5 [95%CI：9.8-100.6]，p<0.0001）和 BCC 发展（OR：2.3 [95%CI：1.6-3.3]，p<0.0001），首次 SCC 诊断前平均 AK 诊断时间为 3.1 年（p<0.0001）。相应地，虽然无 AK 的 SOTR 中 SCC 的风险在移植后 25 年为 1.4%，但有 AK 的 SOTR 在移植后 10 年 SCC 的风险为 23%。其他确定的风险因素包括 Fitzpatrick 皮肤类型 I（BCC：OR：2.4 [95%CI：1.2-5.0]，p=0.018；SCC：3.2 [95%CI：1.2-8.2]，p=0.016）和移植持续时间>15 年（BCC：OR：1.8 [95%CI：1.2-2.7]，p=0.007）。未显示皮肤癌发展与性别或免疫抑制方案之间存在显著关联。
角质形成细胞癌与 SOTR 中的 AK 诊断密切相关，应促使受影响个体加强皮肤癌筛查。
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