■光化性角化病(AK)是常见的癌前皮肤病变,发展为皮肤鳞状细胞癌(SCC)的风险很小。有一些证据表明,AKs患者患SCC以外的其他皮肤癌的风险也增加。然而,AKs患者患皮肤癌的绝对风险尚不清楚.
■计算患有AK的Medicare受益人未来皮肤癌的绝对和相对风险。
■这项回顾性队列研究是使用一项不确定的,2009年至2018年4999999按服务收费的医疗保险受益人的随机抽样。包括接受过治疗的AKs患者,将脂溢性角化病(SKs)患者作为对照组.所有患者都需要在数据集输入和第一次AK或SK之间至少有1年的时间。有皮肤癌病史的患者被排除在外。数据从2022年9月到2023年3月进行了分析。
■结果首先是手术治疗的皮肤癌,包括角质形成细胞癌(包括SCC和基底细胞癌[BCC])和黑色素瘤。评估AKs患者皮肤癌的绝对风险。使用调整后的竞争风险回归将AKs患者的皮肤癌风险与SKs患者进行比较。
■共有555945名AKs患者(平均[SD]年龄,74.0[7.4]岁;55.4%为女性)和481024例SKs患者(平均[SD]年龄,73.3[7.3]岁;72.4%为女性)。第一次AK后1年皮肤癌的绝对风险为6.3%(95%CI,6.3%-6.4%),3年为18.4%(95%CI,18.3%-18.5%),5年为28.5%(95%CI,28.4%-28.7%)。与SKs患者相比,AKs患者患皮肤癌的风险增加(任何皮肤癌:调整后的风险比[aHR],2.17;95%CI,2.15-2.19;角质形成细胞癌:aHR,2.20;95%CI,2.18-2.22;SCC:aHR,2.63;95%CI,2.59-2.66;BCC:aHR,1.85;95%CI,1.82-1.87;黑色素瘤:aHR,1.67;95%CI,1.60-1.73)。
■在这项队列研究中,患有AKs的老年患者有相当大的绝对风险,以及升高的相对风险,皮肤癌。AKs可能是紫外线暴露和皮肤癌风险增加的临床标志物,包括SCC,密件抄送,还有黑色素瘤.然而,缺乏AKs患者后续皮肤癌监测指南.努力为AK患者的皮肤癌监测制定循证建议至关重要。
Actinic keratoses (AK) are common premalignant skin lesions with a small risk of progressing to cutaneous squamous cell carcinoma (SCC). There is some evidence that patients with AKs also have increased risks of other skin cancers beyond SCC. However, the absolute risks of skin cancer in patients with AKs are unknown.
To calculate the absolute and relative risks of future skin cancer in Medicare beneficiaries with AKs.
This retrospective cohort study was performed using a deidentified, random sample of 4 999 999 fee-for-service Medicare beneficiaries from 2009 through 2018. Patients with treated AKs were included, and patients with seborrheic keratoses (SKs) were included as a comparator group. All patients were required to have at least 1 year between data set entry and first AK or SK. Patients with a history of skin cancer were excluded. Data were analyzed from September 2022 to March 2023.
Outcomes were first surgically treated skin cancer, including keratinocyte carcinoma (including SCC and basal cell carcinoma [BCC]) and melanoma. The absolute risks of skin cancer in patients with AKs were evaluated. Skin cancer risks in patients with AKs were compared with patients with SKs using adjusted competing risks regression.
A total of 555 945 patients with AKs (mean [SD] age, 74.0 [7.4] years; 55.4% female) and 481 024 patients with SKs (mean [SD] age, 73.3 [7.3] years; 72.4% female) were included. The absolute risk of skin cancer after a first AK was 6.3% (95% CI, 6.3%-6.4%) at 1 year, 18.4% (95% CI, 18.3%-18.5%) at 3 years, and 28.5% (95% CI, 28.4%-28.7%) at 5 years. Patients with AKs had increased risk of skin cancer compared with patients with SKs (any skin cancer: adjusted hazard ratio [aHR], 2.17; 95% CI, 2.15-2.19; keratinocyte carcinoma: aHR, 2.20; 95% CI, 2.18-2.22; SCC: aHR, 2.63; 95% CI, 2.59-2.66; BCC: aHR, 1.85; 95% CI, 1.82-1.87; and melanoma: aHR, 1.67; 95% CI, 1.60-1.73).
In this cohort study, older patients with AKs had substantial absolute risks, as well as elevated relative risks, of skin cancer. AKs may be clinical markers of UV exposure and increased skin cancer risk, including SCC, BCC, and melanoma. However, guidelines are lacking for follow-up skin cancer surveillance in patients with AKs. Efforts to develop evidence-based recommendations for skin cancer surveillance in patients with AKs are paramount.