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The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan.
J Am Acad Dermatol. 2011 Jul; 65(1):84-91.JA

Abstract

BACKGROUND

An association between psoriasis and malignancy has been explored. However, no studies have been reported regarding cancer risk in Asian psoriasis populations.

OBJECTIVES

The aim of this study was to investigate the risk of cancer development in association with psoriasis. The effects of age at diagnosis, treatment modalities, and observation time were also evaluated.

METHODS

Data for this retrospective population-based cohort study were obtained from the Taiwan National Health Insurance Research Database (NHIRD). This study included 3,686 patients with first-time diagnosis of psoriasis between 1996 and 2000. Another 200,000 patients without psoriasis served as the comparison group. All enrolled subjects were followed-up until the end of 2007. Cumulative incidences and hazard ratios (HRs) of cancer development were determined.

RESULTS

Among the 3,686 psoriasis patients, 116 had incident cancers. The 7-year cumulative incidence of cancer among psoriasis patients was 4.8%. The adjusted HR for developing a cancer in association with psoriasis was 1.66 (95% confidence interval [CI], 1.38-2.00). Cancer risk was higher in male patients than in female patients (adjusted HR 1.86 vs.1.14, respectively). Certain cancers were significantly associated with psoriasis, including those of the urinary bladder and skin, followed by oropharynx/larynx, liver/gallbladder, and colon/rectum. Patients with psoriasis had an increased adjusted HR for cancer that varied by age. Younger patients with psoriasis tended to have the greatest risk of cancer. Finally, systemic phototherapy and oral medication did not significantly increase the risk of cancer. Phototherapy with UVB appeared to reduce the risk of cancer in psoriasis (adjusted HR, 0.52; 95% CI, 0.29-0.95; P = .03).

LIMITATIONS

NHIRD did not contain information regarding severity of psoriasis, status of smoking, alcohol use, family history of cancer, or diet. Misclassification of disease cannot be ruled out in a registry-based database.

CONCLUSIONS

Psoriasis carries an elevated risk of malignancies, especially in younger and in male patients. This effect is independent of systemic treatment for psoriasis. Finally, phototherapy with UVB did not increase, but rather reduced, the risk of cancer in psoriasis.

Authors+Show Affiliations

Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21458106

Citation

Chen, Yi-Ju, et al. "The Risk of Cancer in Patients With Psoriasis: a Population-based Cohort Study in Taiwan." Journal of the American Academy of Dermatology, vol. 65, no. 1, 2011, pp. 84-91.
Chen YJ, Wu CY, Chen TJ, et al. The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan. J Am Acad Dermatol. 2011;65(1):84-91.
Chen, Y. J., Wu, C. Y., Chen, T. J., Shen, J. L., Chu, S. Y., Wang, C. B., & Chang, Y. T. (2011). The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan. Journal of the American Academy of Dermatology, 65(1), 84-91. https://doi.org/10.1016/j.jaad.2010.04.046
Chen YJ, et al. The Risk of Cancer in Patients With Psoriasis: a Population-based Cohort Study in Taiwan. J Am Acad Dermatol. 2011;65(1):84-91. PubMed PMID: 21458106.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The risk of cancer in patients with psoriasis: a population-based cohort study in Taiwan. AU - Chen,Yi-Ju, AU - Wu,Chun-Ying, AU - Chen,Tzeng-Ji, AU - Shen,Jui-Lung, AU - Chu,Szu-Ying, AU - Wang,Chang-Bi, AU - Chang,Yun-Ting, Y1 - 2011/03/31/ PY - 2009/10/01/received PY - 2010/04/16/revised PY - 2010/04/26/accepted PY - 2011/4/5/entrez PY - 2011/4/5/pubmed PY - 2011/8/27/medline SP - 84 EP - 91 JF - Journal of the American Academy of Dermatology JO - J. Am. Acad. Dermatol. VL - 65 IS - 1 N2 - BACKGROUND: An association between psoriasis and malignancy has been explored. However, no studies have been reported regarding cancer risk in Asian psoriasis populations. OBJECTIVES: The aim of this study was to investigate the risk of cancer development in association with psoriasis. The effects of age at diagnosis, treatment modalities, and observation time were also evaluated. METHODS: Data for this retrospective population-based cohort study were obtained from the Taiwan National Health Insurance Research Database (NHIRD). This study included 3,686 patients with first-time diagnosis of psoriasis between 1996 and 2000. Another 200,000 patients without psoriasis served as the comparison group. All enrolled subjects were followed-up until the end of 2007. Cumulative incidences and hazard ratios (HRs) of cancer development were determined. RESULTS: Among the 3,686 psoriasis patients, 116 had incident cancers. The 7-year cumulative incidence of cancer among psoriasis patients was 4.8%. The adjusted HR for developing a cancer in association with psoriasis was 1.66 (95% confidence interval [CI], 1.38-2.00). Cancer risk was higher in male patients than in female patients (adjusted HR 1.86 vs.1.14, respectively). Certain cancers were significantly associated with psoriasis, including those of the urinary bladder and skin, followed by oropharynx/larynx, liver/gallbladder, and colon/rectum. Patients with psoriasis had an increased adjusted HR for cancer that varied by age. Younger patients with psoriasis tended to have the greatest risk of cancer. Finally, systemic phototherapy and oral medication did not significantly increase the risk of cancer. Phototherapy with UVB appeared to reduce the risk of cancer in psoriasis (adjusted HR, 0.52; 95% CI, 0.29-0.95; P = .03). LIMITATIONS: NHIRD did not contain information regarding severity of psoriasis, status of smoking, alcohol use, family history of cancer, or diet. Misclassification of disease cannot be ruled out in a registry-based database. CONCLUSIONS: Psoriasis carries an elevated risk of malignancies, especially in younger and in male patients. This effect is independent of systemic treatment for psoriasis. Finally, phototherapy with UVB did not increase, but rather reduced, the risk of cancer in psoriasis. SN - 1097-6787 UR - https://www.unboundmedicine.com/medline/citation/21458106/The_risk_of_cancer_in_patients_with_psoriasis:_a_population_based_cohort_study_in_Taiwan_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0190-9622(10)00557-8 DB - PRIME DP - Unbound Medicine ER -