PO.CL11.02 · 临床研究
非黑色素瘤皮肤癌与斑秃之间的负相关：一项系统评价与荟萃分析
The inverse association between non-melanoma skin cancer and alopecia areata: A systematic review and meta-analysis
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
非黑色素瘤皮肤癌（NMSC），包括基底细胞癌（BCC）和鳞状细胞癌（SCC），是全球最常见的恶性肿瘤，在生存护理中仍具有临床相关性。虽然许多自身免疫性疾病伴有癌症风险升高，但斑秃（AA）——一种T细胞介导的自身免疫性疾病——可能反而赋予增强的皮肤肿瘤免疫监视。我们进行了一项系统评价和荟萃分析，以评估AA中的NMSC风险，并评估其作为免疫介导癌症保护的人类模型的潜力。检索了PubMed、Embase、Scopus和ClinicalTrials.gov截至2025年7月的观察性研究，这些研究报告了AA与对照相比的BCC或SCC发病率。效应估计值采用随机效应模型进行合并，并采用REML和Hartung-Knapp校正。异质性采用I2和留一法敏感性分析评估。八项回顾性队列（n=854,000例AA患者）符合纳入标准，四项报告了BCC结局，五项报告了SCC结局。在各研究中，AA患者始终显示出较对照更低的皮肤癌发病率（OR 0.58；95% CI，0.27-1.22）。合并估计值提示BCC（OR 0.43；95% CI，0.11-1.75）和SCC（OR 0.66；95% CI，0.28-1.57）风险降低，尽管两者均未达到统计学意义。研究间异质性较高（I2>80%），反映出研究设计、病例确认，以及对UV暴露、皮肤光型和治疗史校正方面的差异。敏感性分析证实了保护性方向的稳定性，未检测到发表偏倚的证据。这些发现支持AA与NMSC之间可能存在负相关，这与其他自身免疫状况中所见的恶性肿瘤模式形成对比。AA可能代表一种皮肤免疫监视增强的自然模型，与在JAK抑制和免疫信号传导背景下理解癌症风险相关。有必要开展进一步的前瞻性研究，采用标准化的结局定义并纳入多样化的患者人群，以验证这一关联并探索其对癌症预防和生存护理的转化意义。
查看英文原文 English abstract
Non-melanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are the most common malignancies worldwide and remain clinically relevant in survivorship care. While many autoimmune diseases carry increased cancer risk, alopecia areata (AA), a T cell-mediated autoimmune disease, may instead confer enhanced cutaneous tumor immunosurveillance. We conducted a systematic review and meta-analysis to evaluate NMSC risk in AA and assess its potential as a human model of immune-mediated cancer protection. PubMed, Embase, Scopus, and ClinicalTrials.gov were searched through July 2025 for observational studies reporting BCC or SCC incidence in AA versus controls. Effect estimates were pooled using random-effects models with REML and Hartung-Knapp adjustment. Heterogeneity was assessed with I 2 and leave-one-out sensitivity analyses. Eight retrospective cohorts (n = 854,000 AA patients) met inclusion criteria, four reported BCC and five SCC outcomes. Across studies, AA patients consistently demonstrated lower skin cancer incidence compared with controls (OR 0.58; 95% CI, 0.27-1.22). Pooled estimates suggested reduced risk for BCC (OR 0.43; 95% CI, 0.11-1.75) and SCC (OR 0.66; 95% CI, 0.28-1.57), though neither reached statistical significance. Between-study heterogeneity was high (I 2 > 80%), reflecting differences in study design, case ascertainment, and adjustment for UV exposure, phototype, and treatment history. Sensitivity analyses confirmed stability of the protective direction, with no evidence of publication bias detected. These findings support a possible inverse association between AA and NMSC, contrasting with malignancy patterns seen in other autoimmune conditions. AA may represent a natural model of heightened cutaneous immune surveillance, with relevance to understanding cancer risk in the context of JAK inhibition and immune signaling. Further prospective studies with standardized outcome definitions, including diverse patient populations, are warranted to validate this association and explore translational implications for cancer prevention and survivorship care.
利益披露 Disclosure
S. I. Gaumond, None..
K. Nouri, None..
A. Tosti, None.