Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Region Västra Götaland, Sahlgrenska University Hospital, Department of Dermatology and Venereology, Gothenburg, Sweden.
Br J Cancer. 2023 Mar;128(7):1311-1319. doi: 10.1038/s41416-023-02172-7. Epub 2023 Feb 4.
Methotrexate (MTX) use has been suspected of increasing the risk of skin cancer. The aim of this investigation was to examine the association between the use of MTX and the risk of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (cSCC) and cutaneous malignant melanoma (CMM).
In a nationwide Danish case-control study, we identified incident, histologically verified cases of BCC (n = 131,447), cSCC (n = 18,661) or CMM (26,068) from 2004 to 2018. We matched 10 controls to each case on sex and birth year using risk-set sampling and computed crude and adjusted odds ratios (ORs) using conditional logistic regression for the use of MTX (≥2.5 g) compared with never-use.
Use of MTX was associated with increased risk of BCC, cSCC and CMM with adjusted ORs of (95% confidence interval) 1.29 (1.20-1.38), 1.61 (1.37-1.89) and 1.35 (1.13-1.61), respectively. For BCC and cSCC, ORs increased with higher cumulative doses. When restricting the study population to patients with psoriasis, the ORs were 1.43 (1.23-1.67), 1.18 (0.80-1.74) and 1.15 (0.77-1.72), respectively.
We observed an increased risk of BCC and cSCC associated with the use of MTX with evidence of a dose-response pattern; however, the association was not consistent when restricting the study population to patients with psoriasis.
甲氨蝶呤（MTX）的使用已被怀疑会增加皮肤癌的风险。本研究旨在探讨 MTX 的使用与基底细胞癌（BCC）、皮肤鳞状细胞癌（cSCC）和皮肤恶性黑色素瘤（CMM）风险之间的关系。
在一项全国性的丹麦病例对照研究中，我们从 2004 年至 2018 年确定了 BCC（n=131447）、cSCC（n=18661）或 CMM（26068）的发病例，这些病例均经过组织学验证。我们采用风险集抽样，按性别和出生年份为每个病例匹配 10 个对照，使用条件逻辑回归计算 MTX（≥2.5g）使用与从不使用相比的粗比值比（OR）和调整比值比（OR）。
MTX 的使用与 BCC、cSCC 和 CMM 的风险增加相关，调整后的 OR（95%置信区间）分别为 1.29（1.20-1.38）、1.61（1.37-1.89）和 1.35（1.13-1.61）。对于 BCC 和 cSCC，OR 随着累积剂量的增加而增加。当将研究人群限制为银屑病患者时，OR 分别为 1.43（1.23-1.67）、1.18（0.80-1.74）和 1.15（0.77-1.72）。
我们观察到 MTX 的使用与 BCC 和 cSCC 的风险增加有关，并且存在剂量-反应关系的证据；然而，当将研究人群限制为银屑病患者时，这种关联并不一致。
