Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease.
Risk of melanoma and nonmelanoma skin cancer among patients with inflammatory bowel disease.
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DOI：
10.1053/j.gastro.2012.05.004
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发表时间：
2012-08
期刊：
影响因子：
29.4
通讯作者：
Kappelman MD
中科院分区：
文献类型：
--
作者：
Long MD;Martin CF;Pipkin CA;Herfarth HH;Sandler RS;Kappelman MD
炎症性肠病(IBD)患者有患某些恶性肿瘤的风险。我们的目标是确定IBD患者患黑色素瘤和非黑色素瘤皮肤癌(NMSC)的风险，以及药物如何影响这些风险。从1997年到2009年，我们使用LifeLink健康计划索赔数据库中的管理数据进行了回溯性队列和嵌套病例对照研究。队列包括108,579名IBD患者，每个患者与4名非IBD患者匹配。通过发生率比(IRR)和调整的COX比例风险比(HR)模型来评估黑色素瘤和NMSC的风险。在嵌套病例对照研究中，有黑色素瘤或NMSC的患者与4名无黑色素瘤或NMSC的IBD患者相匹配。条件Logistic回归被用来确定药物与两种皮肤癌之间的关联。在队列中，IBD与黑色素瘤发病率的增加相关(IRR，1.29；95%可信区间[CI]，1.09-1.53)。克罗恩病患者的风险最大(IRR，1.45；95%CI，1.13-1.85；调整后的HR，1.28；95%CI，1.00-1.64)。IBD患者NMSC的发生率也增加(IRR，1.46；95%CI，1.40~1.53)，CD患者NMSC发生率最高(IRR，1.64；95%CI，1.54~1.74)。在嵌套病例对照研究中，生物制剂治疗增加了黑色素瘤的风险(优势比[OR]，1.88；95%可信区间，1.08-3.29)。接受硫嘌呤治疗的患者患NMSC的风险增加(OR，1.85；95%CI，1.66-2.05)。免疫抑制增加了IBD患者患黑色素瘤和NMSC的风险。使用生物制剂会增加患黑色素瘤的风险，使用硫代嘌呤会增加患NMSC的风险。IBD患者应该得到皮肤癌的咨询和监测。
Patients with inflammatory bowel disease (IBD) are at risk for certain malignancies. We aimed to determine the risk of melanoma and nonmelanoma skin cancer (NMSC) in patients with IBD and how medications affect these risks. We performed retrospective cohort and nested case-control studies using administrative data from the LifeLink Health Plan Claims Database from 1997 to 2009. The cohort comprised 108,579 patients with IBD, and each was matched to 4 individuals without IBD. The risk of melanoma and NMSC was evaluated by incidence rate ratio (IRR) and by adjusted Cox proportional hazard ratio (HR) modeling. In nested case-control studies, patients with melanoma or NMSC were matched to 4 patients with IBD without melanoma or NMSC. Conditional logistic regression was used to determine associations between medications and both skin cancers. In the cohort, IBD was associated with an increased incidence of melanoma (IRR, 1.29; 95% confidence interval [CI], 1.09–1.53). Risk was greatest among individuals with Crohn’s disease (IRR, 1.45; 95% CI, 1.13–1.85; adjusted HR, 1.28; 95% CI, 1.00–1.64). The incidence of NMSC also increased among patients with IBD (IRR, 1.46; 95% CI, 1.40–1.53) and was greatest among those with CD (IRR, 1.64; 95% CI, 1.54–1.74). In the nested case-control studies, therapy with biologics increased the risk of melanoma (odds ratio [OR], 1.88; 95% CI, 1.08–3.29). Patients who had been treated with thiopurines had an increased risk of NMSC (OR, 1.85; 95% CI, 1.66–2.05). Immunosuppression increases the risk of melanoma and NMSC among patients with IBD. The risk of melanoma is increased by use of biologics, and the risk of NMSC is increased by use of thiopurines. Patients with IBD should be counseled and monitored for skin cancer.
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