Prurito crónico asociado a cancer.
Association Between Itch and Cancer in 16,925 Pruritus Patients
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- This study characterized the association between pruritus and different cancer types and by racial groups. Patients with pruritus were compared with patients without pruritus. Those patients who had pruritus were more likely to have concomitant malignancy than those without (OR, 5.76), including cancers of the liver, gall bladder and biliary tract, hematopoietic system, and skin. Black patients with pruritus had a higher likelihood of skin, soft tissue, and hematologic malignancies, while white patients had higher likelihood of liver, respiratory, gastrointestinal, and gynecological malignancies.
- Pruritus was most strongly associated with liver, dermatologic, and hematologic malignancies. Common cancers associated with pruritus differ by race.
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Of their cohort, patients with pruritus were 5.76 times more likely to have a malignancy than patients without pruritus. The authors also documented skin eruptions in 36% of the patients with both pruritus and malignancy. Solid organ malignancies had the lowest rates of skin eruption, whereas leukemia had the highest at 45% of cases. Uniquely, the authors stratified patients by race. They demonstrated that African Americans with pruritus had lower odds ratios of liver, skin, lung, GI, and female genital malignancies, and pruritus was reported in black patients with soft tissue, dermatological, and hematological malignancies more often than in whites. This finding is compared with whites with pruritus who had higher odds ratios of liver, respiratory, GI, and gynecological malignancies.
The authors clearly identify that, as a cross-sectional study, they are unable to establish any causality or temporality between pruritus and malignancy; however, one limitation not addressed is that only black and white ethnicities were included. Because the US population is estimated at this point to be made up of around 17% who identify as Hispanic or Latino, a study specifically addressing other ethnicities well represented in the United States would be beneficial.
Abstract
BACKGROUND
Pruritus has been associated with cancer. However, limited data is available on the types of underlying malignancy associated with pruritus.
OBJECTIVE
We sought to characterize the association between pruritus and different cancer types, as well as variations by racial group.
METHODS
Cross-sectional study of patients ≥ 18 years old seen at the Johns Hopkins Health System from 2013-2017. Patients with pruritus were compared to patients without pruritus. Analyses were stratified by race.
RESULTS
Patients with pruritus are more likely to have concomitant malignancy than those without pruritus (OR 5.76; 95% CI 5.53-6.00). Most strongly associated are cancers of the liver, gallbladder and biliary tract, hematopoietic system, and skin. Compared to whites, black patients more frequently have soft tissue, dermatological, and hematological malignancies, and less frequently have liver, respiratory, GI, and gynecological malignancies.
LIMITATIONS
Cross-sectional design precludes analysis of the temporal association between pruritus and malignancy. The study is limited to a single tertiary care center.
CONCLUSION
Pruritus is most strongly associated with cancers of the liver, skin, and hematopoietic system. Black patients with pruritus have a higher likelihood of skin, soft tissue, and hematological malignancies than whites, while whites have higher likelihood of liver, respiratory, GI, and gynecological malignancies.
Additional Info
Association Between Itch and Cancer in 16,925 Pruritus Patients: Experience at a Tertiary Care Center
J Am Acad Dermatol 2018 Sep 11;[EPub Ahead of Print], VA Larson, O Tang, S Stander, S Kang, SG KwatraFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
posted by dermatica at
October 04, 2018
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