Abstract：
Hematopoietic stem cell transplantation (HSCT) has improved outcomes for severe hematologic, malignant, and immune disorders, yet poses an increased risk of subsequent malignancies. This study aimed to examine the risk of skin cancer following HSCT and identify potential risk factors. The search was conducted in MEDLINE, EMBASE, and CINAHL databases until December 2023. Cohort studies reporting standardized incidence ratios (SIRs) for post-HSCT skin cancer or investigating risk factors were included. SIRs, or hazard ratios (HRs) with 95% confidence interval (CI), were calculated using random-effects inverse-variance models. Outcome endpoints were SIRs of skin cancer post-HSCT and risk factors, including gender, chronic graft-versus-host disease (cGVHD), voriconazole exposure, and total body irradiation (TBI). Twenty-six studies involving 164,944 HSCT recipients (allogeneic HSCT, n = 68,637; autologous HSCT, n = 95,435; mean age: 38.5 ± 13.8 years; 71,354 females [43.3%]) were analyzed. Overall, SIR for skin cancer post-HSCT was 7.21 (95% CI 3.98-13.08), with SIRs of 2.25 (95% CI: 1.37-3.68) for autologous HSCT, and 10.18 (95% CI 5.07-20.43) for allogeneic HSCT. Risk factors for skin cancer risk included cGVHD (HR = 2.86 [95% CI: 2.01-4.07]), specifically for basal cell and squamous cell carcinoma (SCC) (HR = 1.80 [95% CI: 1.31-2.46] and HR = 3.68 [95% CI: 2.39-5.68], respectively), male gender (HR = 1.56 [95% CI: 1.15-2.13]), especially for SCC (HR = 1.70 [95% CI: 1.03-2.80]), and voriconazole exposure (HR = 2.01 [95% CI: 1.12-3.61]). TBI showed no statistically significant association with subsequent skin cancer (HR = 1.12 [95% CI: 0.73-1.71]). These findings highlight the importance of rigorous skin cancer surveillance and preventive strategies in HSCT recipients, particularly in male individuals undergoing allogeneic transplants and those with identifiable risk factors, to enable early detection and intervention.
摘要：
造血干细胞移植（HSCT）改善了严重血液学，恶性,和免疫疾病，但也会增加后续恶性肿瘤的风险.这项研究旨在检查HSCT后皮肤癌的风险并确定潜在的危险因素。搜索是在MEDLINE进行的,EMBASE,和CINAHL数据库，直到2023年12月。包括报告HSCT后皮肤癌的标准化发生率（SIR）或调查危险因素的队列研究。SIR,或具有95%置信区间(CI)的风险比(HR)，使用随机效应逆方差模型计算。结果终点是HSCT后皮肤癌的SIR和危险因素，包括性别,慢性移植物抗宿主病（cGVHD），伏立康唑暴露,和全身照射（TBI）。26项研究涉及164,944名HSCT接受者（同种异体HSCT，n=68,637；自体HSCT，n=95,435；平均年龄：38.5±13.8岁；71,354名女性[43.3％]）进行了分析。总的来说,HSCT后皮肤癌的SIR为7.21（95％CI3.98-13.08），自体HSCT的SIR为2.25（95％CI：1.37-3.68），同种异体HSCT为10.18（95%CI5.07-20.43）。皮肤癌风险的危险因素包括cGVHD（HR=2.86[95％CI：2.01-4.07]），特别是基底细胞和鳞状细胞癌（SCC）（HR=1.80[95％CI：1.31-2.46]和HR=3.68[95％CI：2.39-5.68]，分别)，男性（HR=1.56[95%CI：1.15-2.13]），特别是对于SCC(HR=1.70[95%CI：1.03-2.80])，和伏立康唑暴露（HR=2.01[95%CI：1.12-3.61]）。TBI与后续皮肤癌无统计学意义(HR=1.12[95%CI:0.73-1.71])。这些发现强调了在HSCT接受者中严格的皮肤癌监测和预防策略的重要性。特别是在进行同种异体移植的男性个体和具有可识别的危险因素的个体中，以实现早期检测和干预。
