Kahn H S, Tatham L M, Patel A V, Thun M J, Heath C W
Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA.
JAMA. 1998 Sep 9;280(10):910-2. doi: 10.1001/jama.280.10.910.
Cancer registries have reported an increased incidence of melanoma and certain noncutaneous cancers following nonmelanoma skin cancer (NMSC). Whether these findings were attributable to intensified surveillance, shared risk factors, or increased cancer susceptibility remains unclear.
To determine whether a history of NMSC predicts cancer mortality.
Prospective cohort with 12-year mortality follow-up adjusted for multiple risk factors.
Cancer Prevention Study II, United States and Puerto Rico.
Nearly 1.1 million adult volunteers who completed a baseline questionnaire in 1982.
Deaths due to all cancers and common cancers.
After adjusting for age, race, education, smoking, obesity, alcohol use, and other conventional risk factors, a baseline history of NMSC was associated with increased total cancer mortality (men's relative risk [RR], 1.30; 95% confidence interval [CI], 1.23-1.36; women's RR, 1.26; 95% CI, 1.17-1.35). Exclusion of deaths due to melanoma reduced these RRs only slightly. Mortality was increased for the following cancers: melanoma (RR, 3.36 in men, 3.52 in women); pharynx (RR, 2.77 in men, 2.81 in women); lung (RR, 1.37 in men, 1.46 in women); non-Hodgkin lymphoma (RR, 1.32 in men, 1.50 in women); in men only, salivary glands (RR, 2.96), prostate (RR, 1.28), testis (RR, 12.7), urinary bladder (RR, 1.41), and leukemia (RR, 1.37); and in women only, breast (RR, 1.34). All-cause mortality was slightly increased (adjusted men's RR, 1.03 [95% CI, 1.00-1.06]; women's RR, 1.04 [95% CI, 1.00-1.09]).
Persons with a history of NMSC are at increased risk of cancer mortality. Although the biological mechanisms are unknown, a history of NMSC should increase the clinician's alertness for certain noncutaneous cancers as well as melanoma.
癌症登记处报告称，非黑色素瘤皮肤癌（NMSC）之后黑色素瘤和某些非皮肤癌的发病率有所上升。这些发现是归因于加强监测、共同的风险因素还是癌症易感性增加尚不清楚。
确定NMSC病史是否可预测癌症死亡率。
对多种风险因素进行调整后进行12年死亡率随访的前瞻性队列研究。
美国和波多黎各的癌症预防研究II。
近110万成年志愿者，他们于1982年完成了一份基线调查问卷。
所有癌症和常见癌症导致的死亡。
在对年龄、种族、教育程度、吸烟、肥胖、饮酒及其他传统风险因素进行调整后，NMSC的基线病史与总癌症死亡率增加相关（男性相对风险[RR]为1.30；95%置信区间[CI]为1.23 - 1.36；女性RR为1.26；95% CI为1.17 - 1.35）。排除黑色素瘤导致的死亡后，这些RR仅略有降低。以下癌症的死亡率有所上升：黑色素瘤（男性RR为3.36，女性为3.52）；咽癌（男性RR为2.77，女性为2.81）；肺癌（男性RR为1.37，女性为1.46）；非霍奇金淋巴瘤（男性RR为1.32，女性为1.50）；仅在男性中，唾液腺癌（RR为2.96）、前列腺癌（RR为1.28）、睾丸癌（RR为12.7）、膀胱癌（RR为1.41）和白血病（RR为1.37）；仅在女性中，乳腺癌（RR为1.34）。全因死亡率略有上升（调整后男性RR为1.03 [95% CI为1.00 - 1.06]；女性RR为1.04 [95% CI为1.00 - 1.09]）。
有NMSC病史的人癌症死亡风险增加。虽然生物学机制尚不清楚，但NMSC病史应提高临床医生对某些非皮肤癌以及黑色素瘤的警惕性。
