Queratosis actinicas y riesgo de Carcinoma epidermoide ( >10 queratosis actinios y fuera de cabeza)...

Published in Dermatology

Journal Scan / Research · March 12, 2020

Predicting Keratinocyte Carcinoma in Patients With Actinic Keratosis

The British Journal of Dermatology

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• These authors evaluated 1169 patients with actinic keratoses (AKs) and found that 15.1% (n=176) developed a keratinocyte carcinoma (KC) over a median of 1.8 years. The risk of developing KC in patients with AK can be calculated with this risk-prediction model utilizing the number of AKs at baseline (either 4–9 or ≥10), location of AKs on upper extremities, location of AKs elsewhere besides the head, and coffee consumption.

• Coffee consumption and AKs on the upper extremities were associated with decreased risk of KC, while AKs located outside the head and upper extremities increased the risk. The strongest predictor of development of KC was the presence of ≥10 AKs (HR, 2.44).

– Caroline K. Crabtree, MD

Abstract

BACKGROUND

Patients with actinic keratosis (AK) are at increased risk for developing keratinocyte carcinoma (KC) but predictive factors and their risk rates are unknown.

OBJECTIVES

To develop and internally validate a prediction model to calculate the absolute risk of a first KC in patients with AK.

METHODS

The risk-prediction model was based on the prospective population-based Rotterdam Study cohort. We hereto analysed the data of participants with at least one AK lesion at cohort baseline using a multivariable Cox proportional hazards model and included 13 a priori defined candidate predictor variables considering phenotypic, genetic and lifestyle risk factors. KCs were identified by linkage of the data with the Dutch Pathology Registry.

RESULTS

Of the 1169 AK participants at baseline, 176 (15·1%) developed a KC after a median follow-up of 1·8 years. The final model with significant predictors was obtained after backward stepwise selection and comprised the presence of four to nine AKs [hazard ratio (HR) 1·68, 95% confidence interval (CI) 1·17-2·42], 10 or more AKs (HR 2·44, 95% CI 1·65-3·61), AK localization on the upper extremities (HR 0·75, 95% CI 0·52-1·08) or elsewhere except the head (HR 1·40, 95% CI 0·98-2·01) and coffee consumption (HR 0·92, 95% CI 0·84-1·01). Evaluation of the discriminative ability of the model showed a bootstrap validated concordance index (c-index) of 0·60.

CONCLUSIONS

We showed that the risk of KC in patients with AK can be calculated with the use of four easily assessable predictor variables. Given the c-index, extension of the model with additional, currently unknown predictor variables is desirable.

The British Journal of Dermatology

Predicting Keratinocyte Carcinoma in Patients With Actinic Keratosis: Development and Internal Validation of a Multivariable Risk-Prediction Model

Br J Dermatol 2019 Dec 19;[EPub Ahead of Print], S Tokez, M Alblas, T Nijsten, LM Pardo, M Wakkee