Background

The effectiveness of 5-fluorouracil compared with that of imiquimod for preventing keratinocyte carcinoma is unknown.

Objective

To compare the effectiveness of 5-fluorouracil and that of imiquimod in preventing keratinocyte carcinoma in a real-world practice setting.

Methods

We identified 5700 subjects who filled prescriptions for 5-fluorouracil or imiquimod for treatment of actinic keratosis in 2007. An intention-to-treat analysis controlling for potential confounding variables was used to calculate 2- and 5-year cumulative risk differences for subsequent keratinocyte carcinoma overall and in field-treated areas.

Results

5-Fluorouracil was associated with a statistically significant decreased risk of any keratinocyte carcinoma compared with imiquimod (adjusted hazard ratio [aHR], 0.86; 95% confidence interval [CI], 0.76-0.97), but there were no significant differences in risk by tumor subtype (for squamous cell carcinoma: aHR, 0.89; 95% CI, 0.74-1.07; for basal cell carcinoma: aHR, 0.87; 95% CI, 0.74-1.03) or site-specific keratinocyte carcinoma (aHR, 0.96; 95% CI, 0.81-1.14). There were no significant differences in 2- or 5-year cumulative risk of keratinocyte carcinoma among those treated with 5-fluorouracil versus with imiquimod.

Limitations

Generalizability to other practice settings may be limited.

Conclusions

Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of subsequent site-specific keratinocyte carcinoma in a real-world practice setting.

中文翻译：

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局部氟尿嘧啶和咪喹莫特治疗光化性角化病预防角质形成细胞癌的比较有效性：一项队列研究

背景

尚不清楚5-氟尿嘧啶与咪喹莫特在预防角质形成细胞癌方面的有效性。

客观的

在实际操作中比较5-氟尿嘧啶和咪喹莫特预防角质形成细胞癌的有效性。

方法

我们确定了5700名受试者，他们于2007年填写了用于治疗光化性角化病的5-氟尿嘧啶或咪喹莫特的处方。使用控制潜在混杂变量的意向性治疗分析来计算随后的角质形成细胞癌的2年和5年累积风险差异。总体上和在野外处理的地区。

结果

与咪喹莫特相比，5-氟尿嘧啶与任何角质形成细胞癌的风险降低均具有统计学意义（调整后的危险比[aHR]为0.86； 95％的置信区间[CI]为0.76-0.97），但通过肿瘤亚型（对于鳞状细胞癌：aHR，0.89; 95％CI，0.74-1.07;对于基底细胞癌：aHR，0.87; 95％CI，0.74-1.03）或位点特异性角质形成细胞癌（aHR，0.96; 95％ CI，0.81-1.14）。用5-氟尿嘧啶和咪喹莫特治疗的患者在2或5年的角质形成细胞癌累积风险方面无显着差异。

局限性

对其他练习设置的通用性可能会受到限制。

结论

总体而言，5-氟尿嘧啶在降低角质形成细胞癌风险方面更有效，但在实际操作中，我们发现随后发生的部位特异性角质形成细胞癌的短期或长期风险无差异。