RISK OF SUBSEQUENT BASAL-CELL CARCINOMA AND SQUAMOUS-CELL CARCINOMA OF THE SKIN AMONG PATIENTS WITH PRIOR SKIN-CANCER
RISK OF SUBSEQUENT BASAL-CELL CARCINOMA AND SQUAMOUS-CELL CARCINOMA OF THE SKIN AMONG PATIENTS WITH PRIOR SKIN-CANCER
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DOI：
10.1001/jama.267.24.3305
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发表时间：
1992-06-24
影响因子：
120.7
通讯作者：
STERN, RS
中科院分区：
文献类型：
--
作者：
KARAGAS, MR;STUKEL, TA;STERN, RS
客观。-本研究的主要目的是评估有这些肿瘤既往史的患者中随后发生基底细胞和鳞状细胞皮肤癌的风险，并检查这些风险与患者特征和生活方式因素的关系。β胡萝卜素作为一种可能的皮肤癌预防剂的随机试验参与者的随访。位于加利福尼亚州洛杉矶、加利福尼亚州弗朗西斯科、明尼苏达州明尼阿波利斯和新罕布什尔州汉诺威的临床中心。在1980年1月至1986年2月期间被诊断为基底细胞或鳞状细胞皮肤癌的患者（n=1805），在进入研究时无皮肤癌。从研究开始到首次新发基底细胞和鳞状细胞皮肤癌的时间。3年时发生一种或多种新皮肤癌的估计风险为35%，5年时为50%。新的皮肤癌倾向于与以前的皮肤癌相同的细胞类型。对于基底细胞和鳞状细胞皮肤癌，男性患者的风险更高，年龄超过60岁，有更多的皮肤癌病史，有严重的光化性皮肤损伤，或者容易因阳光照射而灼伤。与从不吸烟的人相比，目前吸烟者（率比，2.01; 95%置信区间，1.21至3.34）和以前吸烟者（率比，1.62; 95%置信区间，1.07至2.47）的后续鳞状细胞皮肤癌的发生率更高，并随着吸烟时间和吸烟量的增加而增加。吸烟和基底细胞皮肤癌之间没有明确的关系;重度吸烟者的发病率较低，但与吸烟时间无关。既往患有非黑色素瘤皮肤癌的患者在5年内发生相同组织学类型的另一种肿瘤的风险很大。以前的皮肤癌，日光损伤和皮肤对阳光照射的敏感性与这种风险特别相关。与吸烟相关的鳞状细胞皮肤癌风险增加值得进一步研究。
Objective.-The primary aims of this study were to assess risk of subsequent basal and squamous cell skin cancer among patients with a prior history of these tumors and to examine these risks in relation to patient characteristics and life-style factors.Design.-Follow-up of participants in a randomized trial of betacarotene as a possible skin cancer preventive agent.Setting.-Clinical centers in Los Angeles, Calif, San Francisco, Calif, Minneapolis, Minn, and Hanover, NH.Participants.-Patients (n=1805) who were diagnosed as having a basal or squamous cell skin cancer between January 1980 and February 1986 and were free of skin cancer at study entry.Main Outcome Measure.-Time from study entry to first new occurrence of basal and squamous cell skin cancer.Results.-The estimated risk of developing one or more new skin cancers was 35% at 3 years and 50% at 5 years. New skin cancers tended to be of the same cell type as the previous skin cancers. For both basal and squamous cell skin cancer, risk was higher among patients who were male, were over the age of 60 years, had more prior skin cancers, had severe actinic skin damage, or who burned easily with sun exposure. Compared with those who had never smoked, the rate of subsequent squamous cell skin cancer was higher among current smokers (rate ratio, 2.01; 95% confidence interval, 1.21 to 3.34) and former smokers (rate ratio, 1.62; 95% confidence interval, 1.07 to 2.47) and increased with both duration and amount smoked. There was no clear relationship between smoking and basal cell skin cancer; the rate appeared lower among heavy smokers but was unrelated to duration of smoking.Conclusions.-Persons with a prior nonmelanoma skin cancer had a substantial 5-year risk of developing another tumor of the same histologic type. Number of previous skin.cancers, solar damage, and skin sensitivity to sun exposure were particularly related to this risk. The increased risk of squamous cell skin cancer associated with cigarette smoking merits further study.