Risk Factors Evaluation for Skin Cancer and Lip Cancer

• Main Authors: Hui-Wen Tseng, 曾慧文
• Other Authors: Yow-Ling Shiue
• Format: Others
• Language: en_US
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/6m2dw3

博士 === 國立中山大學 === 生物醫學研究所 === 106 === The major categories of skin and lip cancer include melanoma and non-melanoma skin cancers (NMSC). NMSC include squamous cell carcinoma, basal cell carcinoma, and malignant neoplasm of sebaceous glands and sweat glands. Skin cancer was among the top 10 most common types of cancers in Taiwan. The two most common types, basal cell carcinoma and squamous cell carcinomas, are highly curable, but can be disfiguring and costly. Melanoma, the third most common, is more dangerous and causes the most deaths. The majority of these three types of skin and lip cancer are caused by exposure to ultraviolet light. The most common etiologies for squamous cell carcinoma and basal cell carcinoma: ultraviolet light exposure, ionizing radiation exposure, and immunosuppression (patients with organ transplant). Exposure to environmental carcinogens is the other important risk factor. Increasing evidence suggests that certain types of cancers are more common in people with certain systemic medical disease, such as diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), and inflammatory systemic autoimmune rheumatic diseases (ISARDs). The people with diabetes mellitus (DM) have increased risk of cancer of the liver, biliary tract, pancreas, stomach, colorectum, kidney, urinary bladder, breast, and endometrium, but conversely a decreased risk of prostate cancer. The aims of the studies were to investigate the risk of skin cancer in patients with diabetes mellitus, and the clinicopathological features and risk factors of patients with lip cancer in Taiwan. The first study is a retrospective cohort study that investigated the risk of skin cancer in patients with DM in Taiwan by using Taiwan Longitudinal National Health Insurance Research Database. The risk of developing overall skin cancer, including non-melanoma skin cancer (NMSC) and melanoma, between the DM and non-DM cohorts was compared by Poisson regression analysis and Cox regression analysis. The DM cohort with newly-diagnosed DM (n=41,898) and a non-DM cohort were one-to-one matched by age, sex, index date, and co-morbidities (coronary artery disease, hyperlipidemia, hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and obesity). Compared with non-DM cohort statistically, for the people with DM aged ≥ 60 years, the incidence rates of overall skin cancer and NMSC were significantly higher [overall: DM/non-DM: number (n) = 99/76, incidence rate ratio (IRR) = 1.44, P = 0.02; NMSC: DM/non-DM: n = 94/66 , IRR=1.57, P = 0.005]. By Cox regression analysis, the risk of developing overall skin cancer or NMSC were significantly higher after adjusting for gender, co-morbidities and overall diseases with immunosuppression status (overall: adjusted hazard ratio (AHR) =1.46, P = 0.01; NMSC: AHR = 1.6, P =0.003). Other significant risk factors were older males for skin cancer (overall: AHR=1.68, P = 0.001; NMSC: AHR=1.59, P = 0.004; melanoma: AHR=3.25, P = 0.04), chronic obstructive pulmonary disease for NMSC (AHR=1.44, P = 0.04) and coronary artery disease for melanoma (AHR= 4.22, P = 0.01). The risk of developing melanoma was lower in the DM cohort than in the non-DM cohort but without significance (AHR= 0.56, P = 0.28; DM/non-DM: n = 5/10). Conclusions were that the incidence rate and risk of developing overall skin cancer, including NMSC, was significantly higher in older adults with DM. Other significant risk factors for older adults with DM were males for NMSC and melanoma, chronic obstructive pulmonary disease for NMSC, and coronary artery disease for melanoma. The second study is a retrospective hospital-based study that investigated the clinicopatholoical characteristics, high-risk lifestyle factors (HRLF: chronic exposure to sun, betel quid, alcohol, and tobacco), and prognostic factors of lip cancer by retrieving the lip cancer from pathological report system in Kaohsiung Veterans General Hospital during 1995-2013. The hospital records of patients with pathologically confirmed lip squamous cell carcinoma (LSCC, n=112) and lip basal cell carcinoma (LBCC, n=21) were reviewed. Differences of clinicopathological characteristics between LSCC and LBCC, upper and lower lip, and status of second primary tumors were compared by Chi-square test and logistic regression. The prognostic factors for LSCC were analyzed by Cox regression. Compared to LBCC patients, LSCC patients were men-predominant (P < 0.001), had younger ages at onset (P < 0.001), and higher rates of lower lips involvement (P < 0.001) and HRLFs. Patients with second primary tumors were highly associated with lower lip cancer involvement (adjusted odds ratio=2.91, P = 0.03). Patients with lower lip cancer had more HRLFs with an increasing linear trend (P = 0.004). The poorer prognostic factors of LSCC for disease-specific survival were advanced stage III/IV [crude hazard ratio (CHR) = 11.16, P < 0.001), tumor dimension >4cm (CHR = 8.19, P = 0.006), lymph node involvement (CHR = 11.48, P < 0.001), and recurrence (CHR = 3.96, P = 0.01); whereas for disease-free survival were moderately to poorly-differentiated LSCC (CHR = 4.97, P = 0.002) and alcohol consumption (CHR = 3.13, P = 0.04). Conclusions were that LSCC and lower lip cancer were highly associated with HRLFs.