Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement.
Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement.
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DOI：
10.1001/jamadermatol.2021.3180
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发表时间：
2021-10-01
期刊：
影响因子：
10.9
通讯作者：
Jambusaria-Pahlajani, Anokhi
中科院分区：
文献类型：
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作者：
Massey, Paul R.;Schmults, Chrysalyne D.;Li, Sara J.;Arron, Sarah T.;Asgari, Maryam M.;Bouwes Bavinck, Jan Nico;Billingsley, Elizabeth;Blalock, Travis W.;Blasdale, Katie;Carroll, Bryan T.;Carucci, John A.;Chong, Alvin H.;Christensen, Sean R.;Chung, Christina Lee;DeSimone, Jennifer A.;Ducroux, Emilie;Escutia-Munoz, Begona;Ferrandiz-Pulido, Carla;Fox, Matthew C.;Genders, Roel E.;Geusau, Alexandra;Gjersvik, Petter;Hanlon, Allison M.;Olasz Harken, Edit B.;Hofbauer, Guenther F. L.;Hopkins, R. Samuel;Leitenberger, Justin J.;Loss, Manisha J.;Del Marmol, Veronique;Mascaro, Jose M., Jr.;Myers, Sarah A.;Nguyen, Bichchau T.;Oliveira, Walmar R. P.;Otley, Clark C.;Proby, Charlotte M.;Racz, Emoke;Ruiz-Salas, Veronica;Samie, Faramarz H.;Seckin, Deniz;Shah, Syed N.;Shin, Thuzar M.;Shumack, Stephen P.;Soon, Seaver L.;Stasko, Thomas;Zavattaro, Elisa;Zeitouni, Nathalie C.;Zwald, Fiona O'Reilly;Harwood, Catherine A.;Jambusaria-Pahlajani, Anokhi
有一个缺乏的证据来指导医生对皮肤鳞状细胞癌（CSCC）的预防策略在实体器官移植受者（SOTR）。为了检查德尔菲过程的发展和结果，该过程旨在确定SOTR中预防CSCC的基于共识的医疗管理建议。邀请具有5年以上SOTR治疗经验的皮肤科医生参加。一种新的光化性损伤和皮肤癌指数（AD-SCI），包括6个顺序阶段，对应于不断增加的负担的光化性损伤和CSCC，被用来指导调查设计。从2019年1月1日到2020年12月31日，进行了三次连续的基于网络的调查。根据德尔菲原则，受访者彻底审查了各轮之间的所有同行的答复。还提出了补充问题，以更好地理解小组成员的答复理由。德尔菲小组由48名皮肤科医生组成。受访者来自13个国家，其中27人（56%）来自美国。29名受访者（60%）是莫氏外科医生。当回答与SOTR中CSCC预防有关的声明、问题或管理策略时，受访者达成了80%或更高的一致性。还定义了70%至低于80%一致性的接近共识类别。如果达成共识或接近共识，则建立基于AD-SCI阶段的建议。专家组能够为6个AD-SCI阶段中的5个阶段提出建议。主要建议包括以下内容：冷冻治疗分散性光化性角化病（AK）;当分组在1个解剖区域时，AK的场治疗，除非AK较厚，在这种情况下，推荐场治疗和冷冻治疗;联合病灶定向和场治疗与氟尿嘧啶治疗场癌变皮肤;开始阿维A治疗，并讨论对多发性皮肤癌患者减少或修改免疫抑制剂，（每年10例CSCC）或发展为高风险CSCC（定义为淋巴结转移风险约≥20%的肿瘤）。对于首次发生低风险CSCC的SOTR，未达成共识建议。在等待高水平证据数据的同时，医生可以考虑实施SOTR中预防CSCC的专家组建议。在尚未达成共识的领域，需要进行更多的临床试验。
There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. Dermatologists with more than 5 years’ experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists’ rationale for their responses. The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage–based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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DOI：
10.1136/bmj.g6679
发表时间：
2014-11-24
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Knoll GA;Kokolo MB;Mallick R;Beck A;Buenaventura CD;Ducharme R;Barsoum R;Bernasconi C;Blydt-Hansen TD;Ekberg H;Felipe CR;Firth J;Gallon L;Gelens M;Glotz D;Gossmann J;Guba M;Morsy AA;Salgo R;Scheuermann EH;Tedesco-Silva H;Vitko S;Watson C;Fergusson DA
通讯作者：
Fergusson DA
影响因子：
1.4
作者：
Mullen, Penelope M
通讯作者：
Mullen, Penelope M
影响因子：
4.5
作者：
Kabir, Zubair;Bennett, Kathleen;Capewell, Simon
通讯作者：
Capewell, Simon
影响因子：
158.5
作者：
Chen, Andrew C.;Martin, Andrew J.;Damian, Diona L.
通讯作者：
Damian, Diona L.
影响因子：
2.4
作者：
De Graaf, YGL;Euvrard, S;Bavinck, JNB
通讯作者：
Bavinck, JNB