Wall James, Gadsby-Davis Kieran, Mistry Khaylen, Levell Nick J, Venables Zoe C
University of East Anglia Norwich Medical School Norwich UK.
Dermatology Norfolk and Norwich University Hospitals NHS Foundation Trust Norwich UK.
Skin Health Dis. 2024 Jun 15;4(4):e405. doi: 10.1002/ski2.405. eCollection 2024 Aug.
Non-melanoma skin cancer (NMSC) is the most common cancer globally in white ethinicity populations, and cutaneous squamous cell carcinoma (cSCC) is the second most common subtype. The COVID-19 pandemic severely impacted public and private healthcare systems. Many studies have reported reduced cancer diagnoses during the pandemic. The impact of the COVID-19 pandemic on global cSCC and NMSC incidence is poorly reported.
The aim was to conduct a systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on global cSCC and NMSC incidence rates, compared with 2019 incidence rates. Two primary outcome measures were used: crude incidence rate ratios (CIRR) and age-standardised incidence rate ratios (ASIRR).
A structured search was undertaken on 23 March 2023 using grey literature and four electronic databases: MEDLINE, CINAHL, EMBASE and Web of Science. Studies published before January 2020 were excluded. A quality assessment was undertaken using A. Lomas quality assessment tool. CIRR outcomes were synthesised in a meta-analysis, while ASIRR outcomes were narratively synthesised.
Fourteen cancer registries were included, capturing data from 13 countries across Europe. Variation was observed in NMSC and cSCC incidence across the cancer registries. Pooled cSCC crude incidence rates in 2020 were equal to crude incidence rates in 2019 (cSCC-CIRR 1.00 (95% confidence interval (CI) 0.94-1.06). In 2021, the pooled result indicated a non-significant 8% increase in cSCC crude incidence rates, compared with 2019 (cSCC-CIRR 1.08 (95% CI 0.98-1.19). Significant reductions were reported in NMSC incidence across all meta-analyses in 2020 and 2021 compared with 2019. Heterogeneity was observed across most pooled estimates ( >75%).
There was a lack of high quality data on cSCC incidence rates recorded during the pandemic outside of Europe. The COVID-19 pandemic resulted in no significant changes in cSCC incidence across Europe. By contrast, NMSC incidence fell across Europe following the pandemic. Significant reductions in pooled NMSC incidence rates may reflect a delay in basal cell carcinoma presentation, diagnosis and treatment. Although annual incidence rates for cSCC were not affected by the pandemic, delays in treatment may still have occurred, which may result in poorer outcomes yet to be fully understood.
非黑色素瘤皮肤癌（NMSC）是全球白种人群中最常见的癌症，皮肤鳞状细胞癌（cSCC）是第二常见的亚型。新冠疫情严重影响了公共和私人医疗系统。许多研究报告称，疫情期间癌症诊断数量减少。关于新冠疫情对全球cSCC和NMSC发病率的影响，相关报道较少。
旨在进行系统评价和荟萃分析，以评估新冠疫情对全球cSCC和NMSC发病率的影响，并与2019年的发病率进行比较。使用了两项主要结局指标：粗发病率比（CIRR）和年龄标准化发病率比（ASIRR）。
于2023年3月23日进行了结构化检索，使用了灰色文献和四个电子数据库：MEDLINE、CINAHL、EMBASE和科学网。排除2020年1月之前发表的研究。使用A. Lomas质量评估工具进行质量评估。CIRR结局在荟萃分析中进行综合，而ASIRR结局则进行叙述性综合。
纳入了14个癌症登记处，收集了来自欧洲13个国家的数据。在不同癌症登记处观察到NMSC和cSCC发病率存在差异。2020年cSCC合并粗发病率与2019年粗发病率相等（cSCC - CIRR 1.00（95%置信区间（CI）0.94 - 1.06）。2021年，汇总结果表明，与2019年相比，cSCC粗发病率无显著增加8%（cSCC - CIRR 1.08（95% CI 0.98 - 1.19）。与2019年相比，2020年和2021年所有荟萃分析中均报告NMSC发病率显著降低。在大多数汇总估计中观察到异质性（>75%）。
欧洲以外地区在疫情期间记录的cSCC发病率缺乏高质量数据。新冠疫情导致欧洲cSCC发病率没有显著变化。相比之下，疫情后欧洲NMSC发病率下降。汇总的NMSC发病率显著降低可能反映了基底细胞癌出现、诊断和治疗的延迟。尽管cSCC的年发病率未受疫情影响，但治疗延迟可能仍然发生，这可能导致尚未完全了解的较差结局。
