20年来美国护士侵袭性鳞癌发病率翻倍

北卡罗莱纳州罗利市——在过去20年间，美国非医生医务人员中浸润性鳞状细胞癌(SCC)的发病率增加了1倍以上，并且在身体部位分布上具有明显的性别差异。

布里格姆妇女医院的Khang Nguyen博士指出：“我们对SCC流行病学的了解多数来自20世纪90年代甚至更早期进行的研究。”为了填补这一研究空白，Nguyen博士及其同事利用护士健康研究中的大约121,000例女性受试者、护士健康研究Ⅱ中的约117,000例受试者和医务人员随访研究中的51,000例男性受试者的数据，对病理学确认浸润性SCC的病例进行了分析。Nguyen博士指出，国立癌症研究所的SEER(监督、流行病学和最终结果)数据库以及其他国家数据库的肿瘤记录统计中不追踪SCC，因此采用了上述3项研究的数据。在这3项研究中分别有1,580、468和1,194例患者病理学诊断为浸润性SCC。

分析结果显示，在护士健康研究中，浸润性SCC的发生率由1987年的40例/10万患者-年攀升至2005年的120例/10万患者-年，2007年又回落至80例/10万患者-年。护士健康研究Ⅱ是一个较年轻的队列，浸润性SCC发病率也较低。在医务人员随访研究的男性受试者中，1987年的浸润性SCC发病率为80例/10万患者-年，顶峰在2002年，超过了160例/10万患者-年，之后略有降低，2007年为140例/10万患者-年。

浸润性SCC在男性中的好发部位为头颈部，在女性中为大腿、臀部、腿部和足部。一项多因素逻辑回归分析显示，有意义的浸润性SCC危险因素包括伴有疼痛或水疱的晒伤病史(与风险增加1.2倍相关)和儿童时期6次晒伤病史。浸润性SCC的其他独立危险因素为黑色素瘤和毛发颜色较浅的家族史。

护士健康研究、护士健康研究Ⅱ和医务人员随访研究均由国立卫生研究院资助。Nguyen博士的分析部分由Doris Duke慈善基金会提供的一项基金资助。

爱思唯尔  版权所有

By: BRUCE JANCIN, Internal Medicine News Digital Network

RALEIGH, N.C. – The incidence of invasive squamous cell carcinoma has more than doubled among U.S. nonphysician health professionals in the last 20 years, with marked sex differences evident in body-site distribution.

Dr. Khang Nguyen said his meta-analysis of data drawn from the Nurses' Health Study, the Nurses' Health Study II, and the Health Professionals Follow-Up Study was spurred by the fact that the National Cancer Institute’s SEER (Surveillance, Epidemiology and End Results) database and other national databases that record cancer statistics don’t track squamous cell carcinoma (SCC).

"Much of what we know about the epidemiology of squamous cell carcinoma comes from studies from the 1990s and earlier," noted Dr. Nguyen of Brigham and Women’s Hospital, Boston.

To help rectify this situation, he and his coinvestigators analyzed cases of pathologist-confirmed invasive SCC in the roughly 121,000 female participants in the Nurses’ Health Study, the 117,000 in the Nurses’ Health Study II, and 51,000 men in the Health Professionals Follow-Up Study. There were 1,580 cases in the Nurses’ Health Study, 468 in the Nurses’ Health Study II, and 1,194 in the Health Professionals Follow-Up Study.

Among participants in the Nurses’ Health Study, the incidence of invasive SCC climbed from 40 per 100,000 person-years in 1987 to a peak of 120 per 100,000 person-years in 2005 before declining to 80 per 100,000 in 2007. Rates were lower in the Nurses’ Health Study II, a younger cohort. Among men in the Health Professionals Follow-Up Study, the incidence was 80 per 100,000 person-years in 1987, peaking at more than 160 per 100,000 person-years in 2002, and then falling back slightly to 140 per 100,000 person-years in 2007.

Invasive SCC occurred more often in the head and neck region among men, and in the thigh, buttock, legs, and feet region in women.

The significant risk factors for the malignancy, which emerged from a multivariate logistic regression analysis, included a history of painful or blistering sunburns (with an associated 2.2-fold increased risk) and a history of six or more sunburns in childhood. Other independent risk factors for invasive SCC were a family history of melanoma and lighter hair color.

The Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals Follow-Up Study were funded by the National Institutes of Health. Dr. Nguyen’s analysis was funded in part by a grant from the Doris Duke Charitable Foundation.