Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Department of Dermatology, Oslo University Hospital, Oslo, Norway.
JAMA Dermatol. 2023 Sep 1;159(9):923-929. doi: 10.1001/jamadermatol.2023.2029.
Cutaneous squamous cell carcinoma (cSCC) may occur with multiple primary tumors, metastasize, and cause death both in immunocompetent and immunosuppressed patients.
To study the rates of second cSCC, metastasis, and death from cSCC in patients with and without organ transplant-associated immunosuppressive treatment.
DESIGN, SETTING, AND PARTICIPANTS: This population-based, nationwide cohort study used Cancer Registry of Norway data from 47 992 individuals diagnosed with cSCC at 18 years or older between January 1, 1968, and December 31, 2020. Data were analyzed between November 24, 2021, and November 15, 2022.
Receipt of a solid organ transplant at Oslo University Hospital between 1968 and 2012 followed by long-term immunosuppressive treatment.
Absolute rates of second cSCC, metastasis, and death from cSCC were calculated per 1000 person-years with 95% CIs. Hazard ratios (HRs) estimated using Cox proportional hazard regression were adjusted for age, sex, and year of first cSCC diagnosis.
The study cohort comprised 1208 organ transplant recipients (OTRs) (median age, 66 years [range, 27-89 years]; 882 men [73.0%] and 326 women [27.0%]) and 46 784 non-OTRs (median age, 79 years [range, 18-106 years]; 25 406 men [54.3%] and 21 378 women [45.7%]). The rate of a second cSCC per 1000 person-years was 30.9 (95% CI, 30.2-31.6) in non-OTRs and 250.6 (95% CI, 232.2-270.1) in OTRs, with OTRs having a 4.3-fold increased rate in the adjusted analysis. The metastasis rate per 1000 person-years was 2.8 (95% CI, 2.6-3.0) in non-OTRs and 4.8 (95% CI, 3.4-6.7) in OTRs, with OTRs having a 1.5-fold increased rate in the adjusted analysis. A total of 30 451 deaths were observed, of which 29 895 (98.2%) were from causes other than cSCC. Death from cSCC was observed in 516 non-OTRs (1.1%) and 40 OTRs (3.3%). The rate of death from cSCC per 1000 person-years was 1.7 (95% CI, 1.5-1.8) in non-OTRs and 5.4 (95% CI, 3.9-7.4) in OTRs, with OTRs having a 5.5-fold increased rate in the adjusted analysis.
In this cohort study, OTRs with cSCC had significantly higher rates of second cSCC, metastasis, and death from cSCC than non-OTRs with cSCC, although most patients with cSCC in both groups died from causes other than cSCC. These findings are relevant for the planning of follow-up of patients with cSCC and for skin cancer services.
皮肤鳞状细胞癌 (cSCC) 可能在免疫功能正常和免疫抑制的患者中出现多个原发性肿瘤、转移并导致死亡。
研究有和没有器官移植相关免疫抑制治疗的患者中第二次 cSCC、转移和 cSCC 死亡的发生率。
设计、地点和参与者：这项基于人群的全国性队列研究使用了挪威癌症登记处的数据，纳入了 1968 年 1 月 1 日至 2020 年 12 月 31 日期间 18 岁及以上诊断为 cSCC 的 47992 名个体。数据分析于 2021 年 11 月 24 日至 2022 年 11 月 15 日进行。
在奥斯陆大学医院接受过实体器官移植，随后接受长期免疫抑制治疗。
每 1000 人年计算第二次 cSCC、转移和 cSCC 死亡的绝对发生率，并给出 95%CI。使用 Cox 比例风险回归估计的风险比 (HR) 经年龄、性别和首次 cSCC 诊断年份调整。
研究队列包括 1208 名器官移植受者 (OTR)（中位年龄 66 岁[范围 27-89 岁]；882 名男性[73.0%]和 326 名女性[27.0%]）和 46784 名非 OTR（中位年龄 79 岁[范围 18-106 岁]；25406 名男性[54.3%]和 21378 名女性[45.7%]）。非 OTR 中每 1000 人年第二次 cSCC 的发生率为 30.9（95%CI，30.2-31.6），OTR 为 250.6（95%CI，232.2-270.1），调整分析中 OTR 是其 4.3 倍。每 1000 人年转移的发生率在非 OTR 中为 2.8（95%CI，2.6-3.0），在 OTR 中为 4.8（95%CI，3.4-6.7），调整分析中 OTR 是其 1.5 倍。共观察到 30451 例死亡，其中 29895 例（98.2%）为 cSCC 以外的原因。非 OTR 中有 516 例（1.1%）和 40 例 OTR （3.3%）死于 cSCC。非 OTR 中每 1000 人年 cSCC 死亡的发生率为 1.7（95%CI，1.5-1.8），OTR 为 5.4（95%CI，3.9-7.4），调整分析中 OTR 是其 5.5 倍。
在这项队列研究中，与非 OTR 相比，患有 cSCC 的 OTR 发生第二次 cSCC、转移和 cSCC 死亡的风险显著更高，尽管两组中大多数患有 cSCC 的患者死于 cSCC 以外的原因。这些发现与计划对患有 cSCC 的患者进行随访以及皮肤癌服务相关。
