Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England
Nationwide Incidence of Metastatic Cutaneous Squamous Cell Carcinoma in England
复制标题
DOI：
10.1001/jamadermatol.2018.4219
复制
发表时间：
2019-03-01
期刊：
影响因子：
10.9
通讯作者：
Leigh, Irene M.
中科院分区：
文献类型：
--
作者：
Venables, Zoe C.;Autier, Philippe;Leigh, Irene M.
皮肤鳞状细胞癌（cSCC）是最常见的具有转移潜力的皮肤癌，但流行病学数据很少。自2013年以来，英国国家癌症登记和分析服务（NCRAS）的变化使得原发性和转移性cSCC的数据分析更加准确。目的评估2013年至2015年英国cSCC和转移性cSCC（mcSCC）的全国发病率。设计，地点，这项基于全国人群的研究确定了一组2013年1月1日至12月31日在英格兰患有cSCC和mcSCC的患者，2015.使用来自NCRAS中病理报告的诊断代码识别患者。分析了2017年3月1日至2018年3月1日的数据。主要结局和指标cSCC的性别发病率和风险因素来自NCRAS数据。采用考克斯比例风险回归分析评估cSCC人群中mcSCC的发生风险，以确定mcSCC的指标。（62.7%为男性;中位年龄，80岁[四分位距，72-86岁]），2013年至2015年，英格兰首次登记的cSCC的年龄标准化发生率为77.3/10万人年（PY）（95% CI，76.6-78.0），女性患者为34.1/100 000 PY（95% CI，33.7-34.5）。在较低剥夺五分位数的老年白色男性患者中观察到原发性cSCC肿瘤计数增加。在最长随访36个月后，1.1%的女性和2.4%的男性原发性cSCC的累积mcSCC发生率。在年龄在80 - 89岁的患者中观察到转移风险显著增加，调整后的风险率约为2.00（风险比[HR]，1.23; 95% CI，1.07-1.43），90岁或以上（HR，1.35; 95% CI，1.09-1.66），男性（HR，1.79; 95% CI，1.52-2.10），免疫抑制（风险比，1.99; 95%可信区间，1.64-2.42），而在较高的贫困五分位数中（最高五分位数的风险比，1.64; 95%可信区间，1.35-2.00）。原发性鳞状细胞癌位于耳（HR，1.70; 95%CI，1.42-2.03）和唇（HR，1.85; 95%CI，1.29-2.63）的转移风险最高。由于卫生保健资源有限和人口老龄化，准确的流行病学数据对于为未来的卫生保健规划提供信息、识别高危患者和评估皮肤癌预防政策至关重要。
IMPORTANCE Cutaneous squamous cell carcinoma (cSCC) is the most common skin cancer with metastatic potential, but epidemiologic data are poor. Changes to the National Cancer Registration and Analysis Service (NCRAS) in England have allowed more accurate data analysis of primary and metastatic cSCC since 2013.OBJECTIVE To assess the national incidence of cSCC and metastatic cSCC (mcSCC) in England from 2013 through 2015.DESIGN, SETTING, AND PARTICIPANTS This national population-based study identified a cohort of patients with cSCC and mcSCC in England from January 1, 2013, through December 31, 2015. Patients were identified using diagnostic codes derived from pathology reports in the NCRAS. Data were analyzed from March 1, 2017, through March 1, 2018.MAIN OUTCOMES AND MEASURES Incidence rates across sex and risk factors for cSCC were derived from the NCRAS data. Risk of occurrence of mcSCC among the population with cSCC was assessed with Cox proportional hazards regression analysis to determine indicators of mcSCC.RESULTS Among the 76 977 patients with first primary cSCC in 2013 through 2015 (62.7% male; median age, 80 years [interquartile range, 72-86 years]), the age-standardized rates for the first registered cSCC in England from 2013 through 2015 were 77.3 per 100 000 person-years (PY) (95% CI, 76.6-78.0) in male patients and 34.1 per 100 000 PY (95% CI, 33.7-34.5) in female patients. Increased primary cSCC tumor count was observed in older, white male patients in lower deprivation quintiles. After a maximum follow-up of 36 months, cumulative incidence of mcSCC developed in 1.1% of women and 2.4% of men with a primary cSCC. Significant increases in the risk of metastasis with adjusted hazard rates of approximately 2.00 were observed in patients who were aged 80 to 89 years (hazard ratio [HR], 1.23; 95% CI, 1.07-1.43), 90 years or older (HR, 1.35; 95% CI, 1.09-1.66), male (HR, 1.79; 95% CI, 1.52-2.10), immunosuppressed (HR, 1.99; 95% CI, 1.64-2.42), and in higher deprivation quintiles (HR for highest quintile, 1.64; 95% CI, 1.35-2.00). Primary cSCC located on the ear (HR, 1.70; 95% CI, 1.42-2.03) and lip (HR, 1.85; 95% CI, 1.29-2.63) were at highest risk of metastasis.CONCLUSIONS AND RELEVANCE This study presents the first national study of the incidence of mcSCC. With limited health care resources and an aging population, accurate epidemiologic data are essential for informing future health care planning, identifying high-risk patients, and evaluating skin cancer prevention policies.