Abstract:
IMPORTANCE:Solid-organ transplant recipients (OTRs) are at an increased risk for skin cancer. Prior studies have demonstrated a reduced incidence of skin cancer in renal OTRs treated with sirolimus. However, little information exists on the use of sirolimus for the prevention of skin cancer in nonrenal OTRs or those already diagnosed as having a posttransplant cancer. OBJECTIVE:To compare subsequent skin cancer formation in a mixed-organ cohort of OTRs who were or were not treated with sirolimus after developing a posttransplant index cancer of any type. DESIGN, SETTING, AND PARTICIPANTS:A 9-year retrospective cohort study at 2 academic tertiary care centers. Electronic medical records were reviewed for OTRs diagnosed as having a posttransplant cancer of any type to determine the type of organ transplanted, pretransplant and posttransplant cancer, and immunosuppressive medications. Patients underwent transplant from January 1, 2000, to December 31, 2008. Data were collected from July 30, 2011, to December 31, 2012, when follow-up was completed, and analyzed from April 28, 2013, to October 4, 2014. MAIN OUTCOMES AND MEASURES:Factors associated with subsequent skin cancer development were evaluated via multivariate Cox regression analysis. RESULTS:Of 329 OTRs with an index posttransplant cancer (100 women and 229 men; mean [SD] age, 56 [19] years), 177 (53.8%) underwent renal transplant; 58 (17.6%), heart transplant; 54 (16.4%), lung transplant; 34 (10.3%), liver transplant; and 6 (1.8%), mixed-organ transplant. Ninety-seven OTRs (29.5%) underwent conversion to sirolimus therapy after diagnosis. One hundred thirty OTRs (39.5%) developed second posttransplant cancers, of which 115 cases (88.5%) were skin cancers. An 11.6% reduction in skin cancer risk was observed in the sirolimus-treated vs non-sirolimus-treated groups overall (26 of 97 [26.8%] vs 89 of 232 [38.4%]; P = .045) and among nonrenal OTRs only (8 of 34 [23.5%] vs 44 of 112 [39.3%], respectively), although the latter difference was not significant (P = .09). Independent predictors of skin cancer formation after the index posttransplant cancer were history of pretransplant skin cancer (subhazard ratio, 2.1; 95% CI, 1.2-3.7), skin cancer as the index posttransplant cancer (subhazard ratio, 5.5; 95% CI, 2.5-6.4), and sirolimus treatment (subhazard ratio, 0.6; 95% CI, 0.4-0.9). These same risk factors were associated with skin cancer formation when the analysis was limited to nonrenal OTRs. No difference was found in allograft rejection or death between sirolimus-treated and non-sirolimus-treated groups. CONCLUSIONS AND RELEVANCE:In this mixed-organ cohort of OTRs, patients taking sirolimus after developing posttransplant cancer had a lower risk of developing subsequent skin cancer, with no increased risk for overall mortality. Thus, conversion to sirolimus therapy may be considered in OTRs who develop cancer if the risk for skin cancer is of concern. Larger studies are needed to quantify sirolimus-associated risk reduction for other cancer types.
journal_name
JAMA Dermatoljournal_title
JAMA dermatologyauthors
Karia PS,Azzi JR,Heher EC,Hills VM,Schmults CDdoi
10.1001/jamadermatol.2015.5548subject
Has Abstractpub_date
2016-05-01 00:00:00pages
533-40issue
5eissn
2168-6068issn
2168-6084pii
2482923journal_volume
152pub_type
杂志文章,多中心研究相关文献
JAMA Dermatology文献大全abstract:IMPORTANCE:Although cutaneous warts are common lesions, full remission is not always achieved with conventional therapies. Laser modalities including carbon dioxide (CO2), erbium:yttrium-aluminum-garnet (Er:YAG), pulsed dye (PDL), and Nd:YAG have been investigated as alternative treatments for warts. OBJECTIVE:To revi...
journal_title:JAMA dermatology
pub_type: 杂志文章,评审
doi:10.1001/jamadermatol.2016.0826
更新日期:2016-09-01 00:00:00
abstract:IMPORTANCE:Ustekinumab is a human monoclonal antibody that binds to the shared p40 subunit of interleukin (IL) 12 and IL-23. It is approved in the United States for adults (>18 years) with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy. In 1 phase 2 trial of ustekinumab for ...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.5728
更新日期:2013-12-01 00:00:00
abstract:IMPORTANCE:Omalizumab has emerged as a novel and effective treatment option for patients with antihistamine-resistant chronic urticaria. It is unclear whether patients with recurrent urticaria symptoms after discontinuation of omalizumab treatment can benefit from retreatment. OBJECTIVE:To assess the response of patie...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.8705
更新日期:2014-03-01 00:00:00
abstract:IMPORTANCE:Mutations driving melanoma growth have diagnostic, prognostic, and therapeutic implications. Traditional classification systems do not correlate optimally with underlying melanoma growth-promoting mutations. Our objective was to determine whether unique dermoscopic growth patterns directly correlate with dri...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.8442
更新日期:2014-06-01 00:00:00
abstract:IMPORTANCE:Lichen sclerosus (LS) is an uncommon chronic inflammatory disease that most commonly affects anogenital skin of postmenopausal women. It typically manifests as atrophic white plaques, which may be accompanied by purpura or fissuring. Rarely, LS has been observed to affect mucosal tissues in the mouth and the...
journal_title:JAMA dermatology
pub_type: 杂志文章,评审
doi:10.1001/jamadermatol.2013.4885
更新日期:2013-10-01 00:00:00
abstract:IMPORTANCE:While monotherapy with biologic agents is effective for many patients with psoriasis, some patients require combination therapy. Evidence-based recommendations on combination therapy provide guidance for treating appropriately selected patients with psoriasis. OBJECTIVE:To make evidence-based, best-practice...
journal_title:JAMA dermatology
pub_type: 杂志文章,评审
doi:10.1001/jamadermatol.2014.3456
更新日期:2015-04-01 00:00:00
abstract:IMPORTANCE:Telaprevir, combined with pegylated interferon alfa and ribavirin, is an efficacious approach to treat hepatitis C virus infection. A morbilliform eruption associated with telaprevir is a common adverse effect experienced by patients. Current guidelines mandate telaprevir discontinuation in any patient with ...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.9938
更新日期:2014-07-01 00:00:00
abstract:IMPORTANCE:Recently, a group of melanocytic tumors with loss of BAP1 expression has been described. The lesions may occur sporadically or as part of a familial cancer syndrome. They have distinct histopathologic features characterized by a nevus like silhouette and cytologic composition of large epithelioid melanocytes...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2013.1529
更新日期:2013-03-01 00:00:00
abstract:Importance:Melanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians. Objective:To determine risk factors and characteristics of renal transplant recipients who develop melanoma. Design, Setting, and Participants:This cohort study of a large nationa...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.2291
更新日期:2017-11-01 00:00:00
abstract:Importance:Despite the growing popularity of cosmetic procedures, the sociocultural and quality-of-life factors that motivate patients to undergo such procedures are not well understood. Objective:To estimate the relative importance of factors that motivate patients to seek minimally invasive cosmetic procedures. Des...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2018.2357
更新日期:2018-10-01 00:00:00
abstract:Importance:Because moisturizer use is critical for the prevention and treatment of numerous dermatological conditions, patients frequently request product recommendations from dermatologists. Objective:To determine the product performance characteristics and ingredients of best-selling moisturizers. Design and Settin...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.3046
更新日期:2017-11-01 00:00:00
abstract:Importance:Dermatologists, pulmonologists, and rheumatologists study and treat patients with sarcoidosis with cutaneous manifestations. The validity of cutaneous sarcoidosis outcome instruments for use across medical specialties remains unknown. Objective:To assess the reliability and validity of cutaneous sarcoidosis...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.2008
更新日期:2015-12-01 00:00:00
abstract:IMPORTANCE:Purse-string suture is a closure method that purportedly reduces the scar area compared with second intention healing. Randomized clinical trials comparing these 2 methods appear to be limited or absent. OBJECTIVE:To determine if purse-string suture improves cosmetic outcome, healing time, and scar to defec...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2014.2313
更新日期:2015-03-01 00:00:00
abstract:IMPORTANCE:Evidence-based treatment guidelines are not available for primary cutaneous mucinous carcinoma (PCMC). OBJECTIVE:To assess outcomes associated with surgical treatment of PCMC. DATA SOURCES:MEDLINE, Cumulative Index to Nursing and Allied Health, and Embase from 1952 to 2010. Search terms were "primary cutan...
journal_title:JAMA dermatology
pub_type: 杂志文章,meta分析,评审
doi:10.1001/jamadermatol.2013.6006
更新日期:2014-04-01 00:00:00
abstract:Importance:Previous studies suggest that depression and anxiety are common in patients with hidradenitis suppurativa (HS), more so than other dermatological conditions. Yet, to the authors' knowledge, no previous systematic review or meta-analysis has estimated the prevalence or odds ratio (OR) for those psychiatric co...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2019.0759
更新日期:2019-06-05 00:00:00
abstract:IMPORTANCE:Primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT), occurs in elderly patients and has been considered as a lymphoma with a poor prognosis, with estimated 5-year specific survival rates of approximately 50%. The hypothesis of an improvement in prognosis over time has not been studied. OB...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamadermatol.2013.7452
更新日期:2014-05-01 00:00:00
abstract:Importance:Dermatofibrosarcoma protuberans (DFSP) is a rare skin cancer that develops in the deep dermis to subcutaneous adipose tissues. A COL1A1-PDGFB gene fusion, leading to the constitutive expression of PDGFB, is the tumorigenic mechanism in most DFSP cases. Objectives:To evaluate the specificity of PDGFB express...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.2389
更新日期:2015-12-01 00:00:00
abstract:Importance:Persistent radiation-induced alopecia (pRIA) and its management have not been systematically described. Objective:To characterize pRIA in patients with primary central nervous system (CNS) tumors or head and neck sarcoma. Design, Setting, and Participants:A retrospective cohort study of patients from Janua...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2020.2127
更新日期:2020-09-01 00:00:00
abstract:Importance:There are limited data among young adults on sunscreen use during childhood and adulthood and on the association of sunscreen use with melanoma risk. Objective:To assess correlates of early-life sunscreen use and the association between sunscreen use and risk of cutaneous melanoma before age 40 years. Desi...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2018.1774
更新日期:2018-09-01 00:00:00
abstract:Importance:A phase 2 trial comparing talimogene laherparepvec plus ipilimumab vs ipilimumab monotherapy in patients with advanced unresectable melanoma found no differential benefit in progression-free survival (PFS) but noted objective response rates (ORRs) of 38.8% (38 of 98 patients) vs 18.0% (18 of 100 patients), r...
journal_title:JAMA dermatology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamadermatol.2018.3958
更新日期:2019-01-01 00:00:00
abstract:IMPORTANCE:Atopic dermatitis (AD) is a common skin condition treated by dermatologists, allergists, pediatricians, and primary care physicians. Several treatment guidelines and therapeutic parameters exist for the management of this disease. Health care professionals may be unaware of guidelines created by specialty or...
journal_title:JAMA dermatology
pub_type: 杂志文章,评审
doi:10.1001/jamadermatol.2015.0250
更新日期:2015-09-01 00:00:00
abstract:Importance:Atopic dermatitis (AD) and allergic contact dermatitis (ACD) have a dynamic relationship not yet fully understood. Investigation has been limited thus far by a paucity of data on the overlap of these disorders in pediatric patients. Objective:To use data from the Pediatric Contact Dermatitis Registry to elu...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2016.6136
更新日期:2017-08-01 00:00:00
abstract:Importance:Incidence rates of skin cancer are increasing globally, and the correct classification of skin lesions (SLs) into benign and malignant tissue remains a continuous challenge. A collective intelligence approach to skin cancer detection may improve accuracy. Objective:To evaluate the performance of 2 well-know...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.3149
更新日期:2015-12-01 00:00:00
abstract:Importance:Erythropoietic protoporphyria (EPP) is a rare hereditary disease of heme biosynthesis that manifests as severe photosensitivity and hepatotoxicity. There have been no effective treatments to date. Cimetidine has been shown to inhibit heme biosynthesis and results in symptomatic improvement in patients with a...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2016.2303
更新日期:2016-11-01 00:00:00
abstract:Importance:Cutaneous squamous cell carcinoma (cSCC) has metastatic potential, but the prognostic value of current staging systems in nonselected patients is uncertain. Objective:To assess the effect of risk factors for metastasis and to evaluate validity and usefulness of 4 staging systems for cSCC using population-ba...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2017.6428
更新日期:2018-04-01 00:00:00
abstract:Importance:Sun-protective behavior affects skin cancer prevention. Shade works by physically shielding skin from direct harmful UV rays; however, skin may still remain exposed to reflected and indirect UV rays. There is no current standard metric to evaluate shade for its effectiveness in sun protection, and there is i...
journal_title:JAMA dermatology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamadermatol.2016.4922
更新日期:2017-03-01 00:00:00
abstract:Importance:Baricitinib, an oral selective Janus kinase 1 and 2 inhibitor, effectively reduced disease severity in moderate to severe atopic dermatitis (AD) in 2 phase 3 monotherapy studies. Objective:To assess the efficacy and safety of 4 mg and 2 mg of baricitinib in combination with background topical corticosteroid...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2020.3260
更新日期:2020-12-01 00:00:00
abstract:IMPORTANCE:Basal cell carcinomas (BCCs) are diagnosed by clinical evaluation, which can include dermoscopic evaluation, biopsy, and histopathologic examination. Recent translation of multiphoton microscopy (MPM) to clinical practice raises the possibility of noninvasive, label-free in vivo imaging of BCCs that could re...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2015.0453
更新日期:2015-10-01 00:00:00
abstract:Importance:Hemophagocytic lymphohistiocytosis (HLH) has been reported as a serious complication of cutaneous T-cell lymphoma (CTCL). Despite available diagnostic guidelines, it remains a diagnostic and therapeutic challenge in this patient population. Objectives:To examine the characteristics of CTCL associated with H...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2018.1264
更新日期:2018-07-01 00:00:00
abstract:IMPORTANCE:Treatment outcomes depend on adherence to the prescribed regimen. Primary nonadherence refers to not obtaining and starting to take a prescribed medication. The frequency of primary nonadherence to acne treatment has not been well characterized. The complexity of multidrug acne regimens may add to this probl...
journal_title:JAMA dermatology
pub_type: 杂志文章
doi:10.1001/jamadermatol.2014.5254
更新日期:2015-06-01 00:00:00