TY - JOUR
T1 - Level of UV Exposure, Skin Type, and Age Are More Important than Thiopurine Use for Keratinocyte Carcinoma Development in IBD Patients
AU - Wu, Yang
AU - Ghaly, Simon
AU - Kerr, Stephen
AU - Jackson, Bryce
AU - Hanigan, Katherine
AU - Martins, Deborah
AU - Krishnaprasad, Krupa
AU - Mountifield, Reme E.
AU - Whiteman, David C.
AU - Bampton, Peter A.
AU - Gearry, Richard B.
AU - Radford-Smith, Graham L.
AU - Lawrance, Ian C.
PY - 2020/4
Y1 - 2020/4
N2 - Background: Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort. Methods: Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire. Results: A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38–19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6–6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4–10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9–16.0). Conclusion: Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.
AB - Background: Retrospective studies observe an increased risk of keratinocyte carcinomas (KCs) in patients with inflammatory bowel disease (IBD) on thiopurine (TP) medication. The role of traditional risk factors such as skin type and sun protection behavior has not been studied in this population. This study aimed to examine traditional KC risk factors and thiopurine use on skin cancer development in an IBD cohort. Methods: Consecutive IBD patients were recruited from four specialist centers in Australia and New Zealand, each with varying UV exposure indices. Data pertaining to race, skin color, freckling and sun protection behavior, dose of TP therapy, and skin cancer development were elicited through a self-reported questionnaire. Results: A total of 691 IBD patients were included with 62 reporting KC development. Thiopurine usage was similar among patients who developed skin cancer compared with those who did not (92% vs. 89%, p = 0.3). There was no statistically significant association between KC development and TP dose or 6-thioguanine nucleotide levels. In multivariate modeling, four factors were independently and significantly associated with KC: age over 61 years old versus less than 30 years old (OR 6.76; 95% CI 2.38–19.18), residing in Brisbane versus Christchurch (OR 3.3; 95% CI 1.6–6.8), never staying in the shade versus staying in the shade ≥ 50% of the time (OR 3.8; 95% CI 1.4–10.5), and having a skin type that never tanned versus other skin types (OR 6.9; 95% CI 2.9–16.0). Conclusion: Skin type, age, and sun protection behavior are more important risk factors for KC development than thiopurine medication use in this IBD population.
KW - Immunosuppression
KW - Inflammatory bowel disease
KW - Skin cancer
KW - Keratinocyte Carcinoma development
KW - thiopurine
UR - http://www.scopus.com/inward/record.url?scp=85073964560&partnerID=8YFLogxK
UR - http://purl.org/au-research/grants/NHMRC/1058522
U2 - 10.1007/s10620-019-05818-w
DO - 10.1007/s10620-019-05818-w
M3 - Article
C2 - 31493039
AN - SCOPUS:85073964560
SN - 0163-2116
VL - 65
SP - 1172
EP - 1179
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 4
ER -