银屑病光化学疗法中的皮肤肿瘤：496例患者的单中心随访

Skin tumors in photochemotherapy for psoriasis: a single-center follow-up of 496 patients.

作者信息

Maier H, Schemper M, Ortel B, Binder M, Tanew A, Hönigsmann H

机构信息

Division of Special and Environmental Dermatology, University of Vienna Medical School, Austria.

出版信息

Dermatology. 1996;193(3):185-91. doi: 10.1159/000246243.

DOI:10.1159/000246243

PMID:8944338

Abstract

BACKGROUND

The significance of oral psoralen photochemotherapy (PUVA) for the development of nonmelanoma skin cancers (NMSC) is still controversial.

OBJECTIVE

We evaluated 496 psoriatics, who received PUVA treatment according to the European PUVA protocol in order to reassess the influence of the cumulative UVA dose on the development of NMSC and to answer the question if there is a UVA threshold dose above which the carcinogenic risk is increased.

METHODS

The study was conducted as a retrospective investigation. All patients were seen personally. Age, sex, skin type, cumulative UVA dose and carcinogenic risk factors (arsenic, X-rays, tar, UVB, methotrexate) were recorded and investigated by marginal (MA) and partial effects analyses (PA) according to the Cox regression model.

RESULTS

In 14 patients (2.8%), one or multiple histologically confirmed NMSC were diagnosed. Nine patients (1.8%) had squamous cell carcinoma (SCC), 5 patients (1.0%) had basal cell carcinoma (BCC). No patient had both types of NMSC. None of the SCC had metastasized. By taking the appearance of BCC and SCC as the endpoint, arsenic [MA: relative risk (RR) = 7.62; PA:RR = 5.36], tar (MA:RR = 4.51; PA:RR = 3.83) and methotrexate (MTX; MA:RR = 4.97; PA:RR = 4.07) appear to produce strong and significant effects (p < 0.05), both in MA and PA. Using the endpoint SCC only, the effect of the natural logarithm of UVA (ln UVA; RR = 2.47), arsenic (RR = 11.2), tar (RR = 9.92) and MTX (RR = 7.1) is significant (p < 0.05) in MA. In PA, only the effect of arsenic (RR = 5.19) is strong and significant (p < 0.05) while the effects of tar (RR = 7.85), MTX (RR = 3.22) and ln UVA (RR = 2.77) are strong but of borderline significance (p = 0.05-0.11). Nonlinear effects of ln UVA on the risk of SCC were far from significant (p > 0.2).

CONCLUSION

PUVA with the European treatment protocol appears to be only a weak carcinogen by itself for SCC with a linear increase in tumor risk but not for BCC development.

摘要

背景

口服补骨脂素光化学疗法（PUVA）对非黑素瘤皮肤癌（NMSC）发生发展的意义仍存在争议。

目的

我们评估了496例银屑病患者，这些患者按照欧洲PUVA方案接受治疗，旨在重新评估累积UVA剂量对NMSC发生发展的影响，并回答是否存在一个UVA阈值剂量，超过该剂量致癌风险会增加这一问题。

方法

本研究为回顾性调查。所有患者均亲自接受检查。记录年龄、性别、皮肤类型、累积UVA剂量和致癌风险因素（砷、X射线、焦油、UVB、甲氨蝶呤），并根据Cox回归模型通过边际（MA）和偏效应分析（PA）进行研究。

结果

14例患者（2.8%）诊断为一种或多种经组织学证实的NMSC。9例患者（1.8%）患有鳞状细胞癌（SCC），5例患者（1.0%）患有基底细胞癌（BCC）。没有患者同时患有这两种类型的NMSC。所有SCC均未发生转移。以BCC和SCC的出现作为终点，砷（MA：相对风险（RR）=7.62；PA：RR = 5.36）、焦油（MA：RR = 4.51；PA：RR = 3.83）和甲氨蝶呤（MTX；MA：RR = 4.97；PA：RR = 4.07）在MA和PA中似乎都产生了强烈且显著的影响（p < 0.05）。仅以SCC作为终点，UVA的自然对数（ln UVA；RR = 2.47）、砷（RR = 11.2）、焦油（RR = 9.92）和MTX（RR = 7.1）在MA中的影响具有显著性（p < 0.05）。在PA中，仅砷（RR = 5.19）的影响强烈且具有显著性（p < 0.05），而焦油（RR = 7.85）、MTX（RR = 3.22）和ln UVA（RR = 2.77）的影响虽强烈但具有临界显著性（p = 0.05 - 0.11）。ln UVA对SCC风险的非线性影响远不显著（p > 0.2）。