Cancer incidence among Finnish patients with psoriasis treated with trioxsalen bath PUVA
Cancer incidence among Finnish patients with psoriasis treated with trioxsalen bath PUVA
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DOI：
10.1016/s0190-9622(96)90721-5
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发表时间：
1996-11-01
影响因子：
13.8
通讯作者：
Karvonen, J
中科院分区：
文献类型：
--
作者：
Hannuksela, A;Pukkala, E;Karvonen, J
背景资料：全身性甲氧沙林PUVA以剂量依赖的方式增加非黑色素瘤皮肤癌的风险，而trioxsalen浴PUVA治疗被认为是bb低致癌性的。目的：我们的目的是研究局部trioxsalen PUVA的致癌性。我们在1977年至1988年期间对337名男性和190名女性银屑病患者进行了记录连锁研究，这些患者接受了Trioxsalen浴PUVA治疗和芬兰癌症登记处（1977年至1993年期间癌症发病率）。平均每人随访时间约为11年。从患者档案中收集关于WA总累积剂量和其他潜在致癌治疗的数据。结果：在随访期间，队列中观察到26例癌症病例，而预期病例数为30例（SIR为0.88，95%可信区间（CI）为0.57-1.28）。显示高SIR的唯一原发部位是肾癌（SIR，3.56; 95% CI，0.97-9.10）和非霍奇金淋巴瘤（SIR，2.94; 95% CI，0.36-10.6）。只有1例非黑色素瘤皮肤癌，预期数量为0.8（SIR，1.26; 95% CI，0.03-7.04）。平均累积UVA剂量为65 J/cm（2）; 40名患者接受了超过200 J/cm（2）。平均治疗次数为112次，65例患者接受了200次以上的治疗。结论：在使用Trioxsalen浴PUVA治疗的患者中，未发现皮肤鳞状细胞癌过度。然而，由于队列规模较小，只能排除7倍的超额风险。银屑病或其治疗与肾癌和淋巴瘤之间的可能联系需要在更大的系列中进一步研究。
Background: Systemic methoxsalen PUVA increases nonmelanoma skin cancer risk in a dose-dependent manner, whereas trioxsalen bath PUVA treatment has been suggested to be bb less carcinogenic.Objective: Our purpose was to study the carcinogenicity of topical trioxsalen PUVA.Methods: We performed a record Linkage study of 337 male and 190 female patients with psoriasis treated with trioxsalen bath PUVA during the period 1977 to 1988 and the Finnish Cancer Registry (cancer incidence in the period 1977 to 1993). The mean follow-up period per person was approximately 11 years. Data on the total cumulative WA dose and other potentially carcinogenic treatments were collected from the patients' files. The standardized incidence ratio (SIR) was calculated, in which the expected number of cases was based on the national cancer incidence rates.Results: During the follow-up, 26 cancer cases were observed in the cohort versus 30 expected (SIR, 0.88, 95% confidence interval [CI], 0.57-1.28). The only primary sites showing high SIRs were cancer of the kidney (SIR, 3.56; 95% CI, 0.97-9.10) and non-Hodgkin's lymphoma (SIR, 2.94; 95% CI, 0.36-10.6). There was only one case of nonmelanoma skin cancer, the expected number was 0.8 (SIR, 1.26; 95% CI, 0.03-7.04). The average cumulative UVA dose was 65 J/cm(2); 40 patients had received more than 200 J/cm(2). The average number of treatments was 112; 65 patients had received more than 200 treatments.Conclusion: No excess of squamous cell carcinoma of the skin was found in patients treated with trioxsalen bath PUVA. However, because of the small size of the cohort, only a sevenfold excess risk can be excluded. The possible associations between psoriasis or its treatment and kidney cancer and lymphoma need to be studied further in larger series.