Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
BMJ Open. 2023 Mar 10;13(3):e071172. doi: 10.1136/bmjopen-2022-071172.
Patients with atopic dermatitis (AD), also known as eczema, may be at an increased risk for malignancies compared with patients without AD; however, incidence rates (IRs) of malignancies in patients with moderate to severe AD are largely unknown. The objective of this study was to evaluate and compare IRs of malignancies in adults with moderate to severe AD (aged ≥18 years).
Retrospective cohort study using data from a Kaiser Permanente Northern California (KPNC) cohort. AD severity classification was adjudicated with medical chart review. Covariates and stratification variables included age, sex and smoking status.
Data were obtained from the KPNC healthcare delivery system in northern California, USA. Cases of AD were defined by outpatient dermatologist-rendered codes and prescriptions of topical therapy or phototherapy (moderate) or systemic treatment (severe).
KPNC health plan members with moderate or severe AD (2007-2018).
Malignancy IRs and 95% CIs per 1000 person-years were calculated.
7050 KPNC health plan members with moderate and severe AD met eligibility criteria for inclusion. IRs (95% CI) were highest for non-melanoma skin cancer (NMSC) in patients with moderate and severe AD (4.6 (95% CI 3.9 to 5.5) and 5.9 (95% CI 3.8 to 9.2), respectively) and breast cancer (2.2 (95% CI 1.6 to 3.0) and 0.5 (95% CI 0.1 to 3.9), respectively). Except for breast cancer, which was only evaluated in women, malignancies were higher (with non-overlapping CIs) in patients with moderate and moderate to severe AD in men versus women for basal cell carcinoma and NMSC and in former versus never smokers for NMSC and squamous cell carcinoma.
This study estimated IRs of malignancies in patients with moderate and severe AD and provides valuable information for dermatology clinicians and ongoing clinical trials in these populations.
特应性皮炎（AD）又称湿疹，患者发生恶性肿瘤的风险可能高于非 AD 患者；然而，中重度 AD 患者恶性肿瘤的发病率（IR）尚不清楚。本研究旨在评估和比较中重度 AD（≥18 岁）成年患者恶性肿瘤的 IR。
使用美国北加州 Kaiser Permanente（KPNC）队列的回顾性队列研究数据。AD 严重程度分类通过病历审查确定。协变量和分层变量包括年龄、性别和吸烟状况。
数据来自美国北加州 KPNC 医疗保健系统。AD 病例由门诊皮肤科医生开具的外用药物或光疗（中度）或全身治疗（重度）的处方代码定义。
KPNC 健康计划中患有中度或重度 AD 的成员（2007-2018 年）。
计算每 1000 人年的恶性肿瘤 IR 及其 95%置信区间。
7050 名符合纳入标准的 KPNC 健康计划中患有中度和重度 AD 的成员。IR（95%CI）最高的是中度和重度 AD 患者的非黑色素瘤皮肤癌（NMSC）（分别为 4.6（95%CI 3.9-5.5）和 5.9（95%CI 3.8-9.2））和乳腺癌（2.2（95%CI 1.6-3.0）和 0.5（95%CI 0.1-3.9））。除仅在女性中评估的乳腺癌外，与女性相比，男性中中度和中重度 AD 患者的基底细胞癌和 NMSC 以及前吸烟者和从不吸烟者的 NMSC 和鳞状细胞癌的恶性肿瘤发生率更高（CI 无重叠）。
本研究估计了中重度 AD 患者恶性肿瘤的 IR，并为皮肤科临床医生和这些人群的正在进行的临床试验提供了有价值的信息。
