PO.CL09.02 · 临床研究
评估系统性硬化症合并器官移植患者的皮肤癌风险：一项队列研究
Assessing skin cancer risk in systemic sclerosis patients with organ transplantation: A cohort study
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
系统性硬化症（SSc）是一种以皮肤和器官纤维化为特征的自身免疫性疾病。癌症是SSc公认的相关疾病，在男性中发病率更高，尤其有证据显示肺癌、乳腺癌和黑色素瘤发病率升高。此外，据报道非黑色素瘤皮肤癌（NMSC）发病率增加，一项研究显示女性发病率高于男性。实体器官或造血干细胞移植——已知会增加NMSC风险——对SSc人群皮肤癌风险的影响尚未得到专门的表征。我们试图探讨有肾脏、骨髓（BM）或肺移植病史的SSc患者的皮肤癌发病情况。
对Mass General Brigham的Research Patient Data Registry从1979年至2024年的临床记录进行查询，检索SSc以及肺、肾或BM移植。对于未暴露队列，将SSc且无移植的患者（每例病例2:1对照）按年龄、性别和种族进行匹配。对每例暴露患者，最多纳入一例匹配的未暴露患者进行分析。在提取的178例暴露和374例未暴露患者中，经病历审查后纳入48例有移植的SSc患者和45例无移植的SSc患者。NMSC风险以基底细胞癌（BCC）或鳞状细胞癌（SCC）计算。
我们观察到皮肤癌与移植的关联增加（相对危险度（RR）5.31，95% p=0.0047），特别是与NMSC相关（RR 4.69，p=0.0097），相较于未移植者。此外，当仅检查移植后出现的皮肤癌时，与对照组相比风险增加（RR 3.75，p=0.0306），特别是SCC（RR=4.69，p=0.0384）。随后对移植患者按性别进行的亚组分析显示，女性皮肤癌风险增加（RR 3.7，p=0.0298）以及NMSC风险增加（RR 3.33，p=0.0468），而男性则无此增加。
SSc患者中的皮肤恶性肿瘤仍研究不足，有必要表征移植对观察到的风险增加的贡献。我们的结果提示，接受移植的SSc患者——特别是女性——与未移植者相比，发生NMSC和皮肤癌的风险可能增加。局限性包括本研究的回顾性质以及因使用单一医疗系统而导致的可推广性有限。
查看英文原文 English abstract
Systemic sclerosis (SSc) is an autoimmune condition characterized by fibrosis of the skin and organs. Cancer is a well-known association of SSc, with a higher incidence in men, and with particular evidence of elevated lung, breast, and melanoma incidence. In addition, non-melanoma skin cancer (NMSC) has been reported to have increased incidence, with one study showing higher incidence in women compared to men. The impact of solid organ or hematopoietic transplantations - known to confer increased risk of NMSC - on skin cancer risk have not been specifically characterized in the SSc population. We sought to explore skin cancer incidence in SSc patients with a history of kidney, bone marrow (BM), or lung transplantation.
The Research Patient Data Registry of Mass General Brigham was queried from 1979 to 2024 for SSc and lung, kidney, or BM transplantation in clinical documentation. For the unexposed cohort, patients with SSc and no transplantation (2:1 controls per case) were matched by age, sex, and race. For each exposed patient, up to one matched unexposed patient was included in the analysis. Among 178 exposed and 374 unexposed extracted, 48 SSc patients with transplant and 45 SSc patients without transplant were included after chart review. NMSC risk was calculated with either basal cell carcinoma (BCC) or squamous cell carcinoma (SCC).
We observed an increased association of skin cancer with transplantation (relative risk (RR) 5.31, 95% p=0.0047), specifically with NMSC (RR 4.69, p=0.0097), compared to non-transplantation. In addition, when examining only skin cancers that emerged after transplantation, there was an increased risk compared to controls (RR 3.75, p=0.0306), specifically with SCC (RR=4.69, p=0.0384). Subsequent subgroup analysis of transplanted patients by sex showed that females had an increased risk of skin cancer (RR 3.7, p=0.0298) and NMSC (RR 3.33, p=0.0468), while males did not.
Cutaneous malignancy amongst SSc patients remains understudied, and characterizing the contribution of transplantation to observed increased risks is necessary. Our results suggest that patients with SSc undergoing transplantation -- specifically females -- may have an increased risk of developing both NMSC and skin cancers compared to those without transplantation. Limitations include our study's retrospective nature and limited generalizability due use of one health system.
利益披露 Disclosure
R. Kanwar, None..
E. Anshelevich, None..
G. Sakunchotpanit, None..
K. Fettel, None..
V. E. Nambudiri, None.