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Occurrence of metachronous basal cell carcinomas: a prognostic model
Author(s) -
Smedinga H.,
Verkouteren J.A.C.,
Steyerberg E.W.,
Hofman A.,
Nijsten T.,
Vergouwe Y.
Publication year - 2017
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/bjd.15771
Subject(s) - medicine , basal cell carcinoma , population , cohort , actinic keratosis , oncology , basal cell , environmental health
Summary Background A third of patients with a first basal cell carcinoma ( BCC ) will develop subsequent (metachronous) BCC s. Objectives To study the prognostic effect of the number of previous BCC diagnosis dates a patient has experienced to derive a prediction model to assess the risk of metachronous BCC s that may inform individualized decision making on surveillance. Methods We considered participants of north‐western European ancestry from a prospective population‐based cohort study (Rotterdam Study). After linkage with the Dutch Pathology Registry, 1077 patients with a first BCC were included. Candidate predictors for metachronous BCC s included patient, lifestyle and tumour characteristics. The prognostic model was developed with Fine and Gray regression analysis to account for competing risk of death. We used bootstrapping to correct for within‐patient correlation and statistical optimism in predictive performance. Results Second to fifth BCC s occurred in 293, 122, 58 and 36 patients, with median follow‐up times of 3·0, 2·1, 1·7 and 1·8 years after the previous BCC , respectively. The risk of a new BCC was higher for patients with more metachronous BCC s. Having more than one BCC at diagnosis was another strong predictor of metachronous BCC s. Discriminative ability of the model was reasonable with an optimism‐corrected c ‐index of 0·70 at 3 years. Conclusions The number of previous BCC diagnosis dates was a strong prognostic factor and should be considered when predicting the risk of metachronous BCC s. When the number of previous BCC diagnosis dates is combined with other readily available characteristics into a prognostic model, patients at high risk of a new BCC can be identified.