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0 => array:4 [ "autoresLista" => "José María Ortiz Salvador, Amparo Pérez-Ferriols, Víctor Alegre de Miquel, Martina Saneleuterio Temporal, Juan José Vilata Corell" "autores" => array:5 [ 0 => array:4 [ "nombre" => "José María" "apellidos" => "Ortiz Salvador" "email" => array:1 [ 0 => "josema.ortiz.salvador@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Amparo" "apellidos" => "Pérez-Ferriols" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Víctor" "apellidos" => "Alegre de Miquel" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span 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"identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario y Politécnico La Fe, Valencia, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Incidencia de cáncer cutáneo distinto del melanoma en pacientes tratados con PUVA oral" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1980 "Ancho" => 2497 "Tamanyo" => 203312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Age of appearance of the first lesion and time until the appearance of the first lesion. Percentage of patients with lesions diagnosed at the start and end of the follow-up period.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Phototherapy with oral psoralen <span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>UVA (oral PUVA therapy) is a form of physical therapy that makes the most of the benefits of this light spectrum. It is used in various dermatological diseases such as psoriasis, atopic dermatitis or mycosis fungoides.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although the carcinogenic effects of ultraviolet light in general and phototherapy in particular are well-known, studies exploring the incidence of non-melanoma skin cancer (NMSC) in the population treated with PUVA therapy are heterogeneous and have short follow-up periods.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The incidence rate of NMSC is variable and depends on the geographic region studied. This is mostly because of the variability in the typical risk factors of this neoplasm (environmental UV irradiance, cutaneous phototype, sun exposure habits, etc.).</p><p id="par0020" class="elsevierStylePara elsevierViewall">The different incidence rate of NMSC in the different published studies makes it difficult to extrapolate results to populations with characteristics that vary from those studied. However, by using standardised rates adjusted to a common population, we are able to compare the results obtained in different populations.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The main objective of this study is to determine the gross and age-adjusted incidence of NMSC in patients treated with PUVA therapy.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and method</span><p id="par0030" class="elsevierStylePara elsevierViewall">A longitudinal retrospective follow-up study was conducted, which included a cohort of patients treated with systemic PUVA between 1982 and 1996 in the Photobiology and Phototherapy Unit of the Valencia University General Hospital.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The inclusion criteria were:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0040" class="elsevierStylePara elsevierViewall">Patients with dermatological diseases treated by oral PUVA in the Photobiology and Phototherapy Unit of the Valencia University General Hospital between 1982 and 1996.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0045" class="elsevierStylePara elsevierViewall">Availability of at least four years’ follow-up data.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0050" class="elsevierStylePara elsevierViewall">Not having received phototherapy regimes other than oral PUVA at any time before treatment or during the study period.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Between 1982 and 1996, 1,012 patients were treated with oral PUVA, of which 234 (23.1%) met the relevant criteria and were thus included in the study. The different exclusions criteria are shown in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Patients with incomplete or absent data in the registry were excluded from the study.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Patients with psoriasis or mycosis fungoides were treated with oral PUVA therapy according to clinical indications and following the protocols established by Carrascosa et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">3</span></a> The eligibility of patients to receive treatment was considered by the health professional in charge of the Photobiology and Phototherapy Unit during the study period.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Patients’ clinical history was accessed and follow-up was carried out until the patient's last registered visit to the Photobiology Unit, with the last access being made in May 2017. The information regarding cutaneous cancer was collected by professionals not involved in this study and sourced from the Valencia General Hospital (reference centre for the entire population served) dermatopathology database and the Valencian Community ABUCASIS II unified clinical database.</p><p id="par0070" class="elsevierStylePara elsevierViewall">Cases of cutaneous neoplasms were considered to be patients with basal cell carcinoma (BCC) or cutaneous epidermoid carcinoma (CEC) included in the clinical database and for whom histologic confirmation was confirmed by biopsy or extirpation. Recommendations from the <span class="elsevierStyleItalic">International Agency for Research on Cancer</span> were followed, defining cases as the first tumour of each histological type in each patient.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The variables registered in the study were sex, age phototherapy was initiated, dermatological pathology, reason for treatment and duration of follow-up. The outcome variables were, prevalence of cutaneous neoplasms according to histological type at the end of the observation period, incidence of NMSC and its subtypes, location of neoplasms, age at the time of appearance of the first neoplasm and time until the development of the first neoplasm.</p><p id="par0080" class="elsevierStylePara elsevierViewall">The prevalence of skin cancer was determined at the end of the follow-up period and the standardised incidence density of cutaneous neoplasms during the follow-up period.</p><p id="par0085" class="elsevierStylePara elsevierViewall">The incidence standardised by age and sex was made by direct adjustment to the world population, as studied by Segi et al. for 18 age groups and both sexes.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">4</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The study was approved by the Valencia General Hospital, Clinical Investigation Ethical Committee.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0095" class="elsevierStylePara elsevierViewall">Of the 234 patients included in the study, 131 (56%) were male and 103 (44%) female. Patients’ age (mean [standard deviation]) at start of treatment was 41.8 (17.4). Their age at the end of the follow-up period was 62.8 (15.5). Mean follow-up time was 21 years (range between 4.1 and 34.5 years) with an accumulated follow-up period of 4.912<span class="elsevierStyleHsp" style=""></span>patients/year.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Fifty neoplasms were diagnosed in 22 patients. The prevalence of NMSC in patients treated with phototherapy was 10.3%, accounting for a single tumour by histological type and patient, and 22.2% considering all tumours. The 50 neoplasms corresponded to 23 BCC and 27 CEC. Considering a tumour by histological type and patient, the prevalence of BCC in the sample was 7.3% and the prevalence of CEC was 4.7%.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Regarding the location of the lesions, the most frequent location was lower limbs (52.8%) followed by the head and neck (34%), the trunk (11.3%) and the lower limb (1.9%).</p><p id="par0110" class="elsevierStylePara elsevierViewall">Considering only one case per tumour and histological type, the incidence density of NMSC in our study (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) was 554.4 cases/100,000 patients treated per year (95% CI: 345.3–763.5). The incidence density of BCC was 352.3 cases/100,000 patients treated per year (95% CI: 184.8–519.8 cases/100,000 patients treated per year). The incidence density of CEC was 229 cases/100,000 patients treated per year (95% CI: 93.7–364.3 cases/100,000 patients treated per year).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">After making a direct standardisation adjusted to the age of the world population, the adjusted incidence density of NSCLC was 183.9 cases/100,000 patients treated per year. The adjusted incidence density of BCC was 111.2 cases/100,000 patients treated per year. The adjusted incidence density of CEC was 77.7 cases/100,000 patients treated per year.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The age of appearance of the first lesion in patients who presented neoplasias and the latency time until its development is shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>. The median time until appearance of the first lesion was 18 years for NMSC in general, 18.3 years for BCC and 12.6 years for CEC. The median age of appearance of the first neoplasm was 67.5 years for NMSC in general, 67.5 years for BCC and 68.4 years for CEC.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0125" class="elsevierStylePara elsevierViewall">To our knowledge, our study, which included 234 patients and a mean follow-up period of 21 years, constitutes the largest known registry in the Mediterranean area.</p><p id="par0130" class="elsevierStylePara elsevierViewall">It is also the first study to define the standardised incidence density of NMSC, which is a much more reliable measure of the risk of carcinogenesis and facilitates comparability with other studies into skin cancer incidence.</p><p id="par0135" class="elsevierStylePara elsevierViewall">From Stern's 1979 study until today, numerous countries have published studies to discern the potential risk of cutaneous tumours in patients who have received PUVA therapy to treat various cutaneous diseases.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a> In the United States, most prospective studies have found a direct association between PUVA therapy and a risk of carcinogenesis.<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5–9</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The risk was greater for the development of squamous cell carcinomas, with increased incidence rates even at low doses of radiation and a directly proportional relationship between the number of sessions and the risk of developing NMSC.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">7</span></a> In Europe, studies have been conducted in Sweden, the United Kingdom, France, Finland, Austria, the Netherlands and Ireland, among others.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10–16</span></a> In four prospective studies and in most of the retrospective studies, an increased risk of NMSC has not been found in patients undergoing treatment with PUVA. Only the most recent cohort studies have found a somewhat higher incidence of NMSC in patients treated with PUVA compared to national tumour registries in each study.<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">10,11,13</span></a> The risk of NMSC in our study is lower than that found in prospective US studies.</p><p id="par0145" class="elsevierStylePara elsevierViewall">The incidence of NMSC found in our study is higher than that found by Vilar-Coromina et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> in the general population of Girona, with a standardised incidence density three times higher than that described in the population of this study (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). The risk was even greater for the development of CPB, with an adjusted incidence in patients treated with PUVA seven times higher than in the unexposed population. These findings are consistent with other studies that defend the carcinogenic risk of PUVA therapy, especially in relation to CEC.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a></p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Our study has found a prevalence of NMSC similar to that of other cohorts of patients treated with PUVA in American studies,<a class="elsevierStyleCrossRefs" href="#bib0135"><span class="elsevierStyleSup">5,9</span></a> and higher than that found in the majority of patients in European studies.<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">18–20</span></a> Regarding the effect on the Mediterranean population, the global prevalence of neoplasias adjusted to the follow-up time concurs with that found by Maiorino et al. in the Italian population.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">21</span></a> However, most of the carcinogenic risk studies associated with PUVA are aged – they have a different inclusion criteria and did not study the incidence rate associated with the follow-up time, only the prevalence at the end of the period, making them very sensitive to differences in the follow-up time.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">2</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The high average age of onset and time to the development of the neoplasm reveal the need for studies with a longer follow-up period. In this sense, these findings are consistent with previous studies, in which the prolongation of observation time is accompanied by an increase in the prevalence of neoplasms.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">9</span></a> In the same way, it validates the observation that the carcinogenic risk associated with PUVA is maintained years after the end of treatment.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">22</span></a> The mean age of onset of NMSC in our study was lower than that found in the general population by Vilar-Coromina et al.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a> This indicates that PUVA therapy not only increases the risk of developing NMSC, but also advances the age of onset of cutaneous neoplasms.</p><p id="par0160" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>, the incidence of cutaneous neoplasms was not homogeneous during the study period, and was closely related to the age of the population. For this reason, caution should be used when defining the incidence of skin cancer as a single value.</p><p id="par0165" class="elsevierStylePara elsevierViewall">Although our study has found an incidence of MCNM higher than that described in the Mediterranean population, this association does not necessarily imply a causal relationship with PUVA therapy has been demonstrated, which may be due to differences not detected in the different study populations or to causal factors not related to UV radiation.</p><p id="par0170" class="elsevierStylePara elsevierViewall">The main limitations of our study are loss of follow-up during the recruitment of patients and during the study period, as well as the retrospective nature of the follow-up. Similarly, there was no cohort of patients not exposed to UV phototherapy with which the incidence of cutaneous neoplasms could have been directly compared and measures of strength of association established.</p><p id="par0175" class="elsevierStylePara elsevierViewall">In conclusion, the incidence of NMSC in patients treated with PUVA therapy was higher than that found in the general population. The risk seems to be greater for the development of CEC than for the BCC. Studies with a prolonged period of follow-up are essential to accurately determine the long-term carcinogenic effect of PUVA therapy.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">None of the authors report having received financial assistance for this manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest in this manuscript.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1207522" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1124524" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1207521" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1124523" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Materials and method" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-14" "fechaAceptado" => "2018-09-27" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1124524" "palabras" => array:6 [ 0 => "PUVA therapy" 1 => "Phototherapy" 2 => "Skin cancer" 3 => "Basal cell carcinoma" 4 => "Squamous cell carcinoma" 5 => "Carcinoma" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1124523" "palabras" => array:6 [ 0 => "PUVAterapia" 1 => "Fototerapia" 2 => "Cáncer de piel" 3 => "Carcinoma basocelular" 4 => "Carcinoma epidermoide" 5 => "Carcinoma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Studies reporting incidences of non-melanoma skin cancer (NMSC) are heterogeneous, depend on the geographic area of the studied population and are often short-term. The aim of this study is to determine the incidence of NMSC in patients treated with oral PUVA therapy in the Mediterranean area.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective, observational study was carried out with a sample of 234 patients treated with systemic PUVA between 1982 and 1996, carrying out a historical follow-up until May 2017. The incidence density rate of CCNM (crude and adjusted) was calculated by direct standardisation. The incidence of CCNM was compared with that reported in the general population in a similar geographical area.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">50 neoplasms were diagnosed in 22 patients. The prevalence of CCNM in patients treated with phototherapy was 10.3%. The mean follow-up time was 21 years. The crude-adjusted incidence density rate of CCNM was 554.4–183.9 cases/100,000 treated patients per year. The crude-adjusted incidence density rate of basal cell carcinoma was 352.3–111.2 cases/100.000 patients and of squamous cell carcinoma was 229–77.7 cases/100,000 patients.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">PUVA therapy is associated with an increased risk of CCNM in the Mediterranean population.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Los trabajos que determinan la incidencia de cáncer cutáneo no melanoma (CCNM) en la población tratada con psoralenos orales<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>UVA son heterogéneos, dependen de la localización geográfica de la población estudiada y tienen períodos de seguimiento cortos. El objetivo del trabajo es determinar la seguridad a largo plazo de la PUVAterapia y en concreto determinar la incidencia de CCNM en los pacientes tratados con PUVAterapia oral en el área mediterránea.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y método</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado un estudio longitudinal de seguimiento retrospectivo, recogiendo 234 pacientes tratados con PUVA sistémico entre 1982 y 1996 con un seguimiento hasta mayo de 2017. Se ha calculado la densidad de incidencia de CCNM bruta y ajustada por edad mediante estandarización directa.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En 22 pacientes se diagnosticaron 50 neoplasias. La prevalencia de CCNM en pacientes tratados con fototerapia fue del 10,3%. El tiempo medio de seguimiento fue de 21 años. la densidad de incidencia bruta-ajustada de CCNM fue de 554,4-183,9 casos/100.000 pacientes tratados-año. La densidad de incidencia bruta-ajustada de carcinoma basocelular fue de 352,3-111,2 casos/100.000 pacientes y la de carcinoma epidermoide de 229-77,7 casos/100.000 pacientes.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La incidencia de cáncer cutáneo en los pacientes tratados con PUVAterapia es superior a la descrita en la población mediterránea.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y método" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ortiz Salvador JM, Pérez-Ferriols A, Alegre de Miquel V, Saneleuterio Temporal M, Vilata Corell JJ. Incidencia de cáncer cutáneo no melanoma en pacientes tratados con PUVAterapia oral. Med Clin (Barc). 2019;152:488–492.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 979 "Ancho" => 1334 "Tamanyo" => 98637 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Flow chart showing the patients selected to participate in the study.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1980 "Ancho" => 2497 "Tamanyo" => 203312 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Age of appearance of the first lesion and time until the appearance of the first lesion. Percentage of patients with lesions diagnosed at the start and end of the follow-up period.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 931 "Ancho" => 1499 "Tamanyo" => 49972 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Incidence of NMSC in patients treated with PUVA therapy compared to the general population of Girona (PG).<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">17</span></a></p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Gross ID (cases/100,000 inhabitants) (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adjusted DI (cases/100,000 inhabitants) (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NMSC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">554.4 (345.3–763.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">183.9 (114.6–253.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BCC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">352.3 (184.8–519.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111.2 (58–164.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CEC \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">229 (93.7–364.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.7 (31.6–123.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">TM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.7 (−15.7–97.13) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.4 (−7.4–44.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2061131.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Crude incidence rate and adjusted age density of NMSC in the population treated with PUVA therapy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:22 [ 0 => array:3 [ "identificador" => "bib0115" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psoralen-ultraviolet A endures as one of the most powerful treatments in dermatology: reinforcement of this “triple-product therapy” by the 2016 British guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "P. 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