童年癌症幸存者中的角化细胞癌：来自童年癌症幸存者研究的报告

Keratinocyte carcinomas in survivors of childhood cancer: A report from the childhood cancer survivor study

JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

影响因子:11.8

分区:医学1区 Top / 皮肤病学1区

发表日期:2024 Dec

作者: Christina Boull, Yan Chen, Cindy Im, Alan Geller, Yadav Sapkota, James E Bates, Rebecca Howell, Michael A Arnold, Miriam Conces, Louis S Constine, Leslie Robison, Yutaka Yasui, Gregory T Armstrong, Joseph P Neglia, Lucie M Turcotte

DOI: 10.1016/j.jaad.2024.07.1520

摘要

童年癌症幸存者（CCS）患角化细胞癌（KC）的风险增加，但单一及多发KC的长期发病率尚未明确。旨在识别危险因素，量化CCS中KC的累积发病率及多发病例的负担。通过对北美1970年至1999年诊断的<21岁癌症患者的5年生存者队列——童年癌症幸存者研究（CCSS）——进行分析，确定KC病例。采用累积发病率估算及多变量模型评估幸存者特征与KC发生率的相关性。在25,658名参与者中，1446人出现5363个KC（其中基底细胞癌占93.5%，鳞状细胞癌占6.7%；平均年龄37.0岁[范围7.3-67.4]；平均潜伏期25.7年；95.3%为白人，88.4%曾接受放疗）。平均病变数为3.7，26.1%的患者经历≥4个病变。放疗显著增加任何KC的发生率（4.5倍）及≥4个KC的发生率（9.4倍）。异基因及自体造血细胞移植也与KC发生率增加（分别为3.4倍和2.3倍）相关。部分自我报告的数据（如种族、皮肤色素类型和既往病史）可能影响分析结果。CCS中KC负担仍然较重，已知的危险因素应指导筛查策略。

Abstract

Childhood cancer survivors (CCS) are at increased risk for keratinocyte carcinomas (KC) however, the long-term incidence of single and multiple KC is not well established.Identify risk factors and quantify KC cumulative incidence and multiple-incidence burden in CCS.KC were identified among Childhood Cancer Survivor Study participants, a cohort of 5-year cancer survivors diagnosed <21 years of age between 1970 and 1999 in North America. Cumulative incidence was estimated and multivariable models assessed relative rates of KC associated with survivor and treatment characteristics.Among 25,658 participants, 1446 developed 5363 KC (93.5% basal cell carcinoma, 6.7% squamous cell carcinoma; mean age 37.0 years (range 7.3-67.4), mean latency 25.7 years; 95.3% White and 88.4% with radiotherapy). Mean lesion count was 3.7 with 26.1% experiencing ≥4. Radiotherapy imparted a 4.5-fold increase in the rate of any KC and 9.4-fold increase in the rate of ≥4 KC. Allogeneic and autologous hematopoietic cell transplant were associated with a 3.4- and 2.3-fold increased rate of KC, respectively.Participant self-reporting of some data including race without skin phototype and past medical history may have impacted analysis.The burden of KC in CCS remains high, but predictable risk factors should guide screening.