Department of Dermatology, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea.
J Dermatol. 2021 May;48(5):585-591. doi: 10.1111/1346-8138.15794. Epub 2021 Mar 5.
Although topical therapies are used to treat extramammary Paget's disease (EMPD), reliable treatment outcomes and the effects of these therapies on subsequent surgical treatments are unclear. To assess the clinical outcomes of topical treatment of EMPD and establish the treatment guidelines the medical records of 166 patients diagnosed with EMPD were retrospectively reviewed. The recurrence rate was evaluated according to the previous use of topical agents. Thirty-four patients (34/166, 20.5%) were initially treated with topical agents such as imiquimod, 5-fluorouracil, and ingenol mebutate. Three patients (3/34, 8.8%) showed clinical response, while 31 patients required subsequent therapy owing to treatment failure. Analysis of the prognostic factors of recurrence in 166 patients revealed that initial topical treatment increased the hazard ratio (HR) in both univariate and multiple Cox proportional hazards models (HR = 3.770, 95% confidence interval [CI] = 1.768-8.037, P = 0.001, and adjusted HR = 3.628, 95% CI = 1.558-8.450, P = 0.003). Patients treated with topical agents showed significantly poorer 3-year recurrence-free survival than the nontreated group (66.3% vs 88.6%, P < 0.001). Topical treatment may be deleterious for some EMPD patients, thus increasing the recurrence risk.
尽管局部治疗被用于治疗乳房外派杰病（EMPD），但可靠的治疗效果以及这些治疗方法对后续手术治疗的影响尚不清楚。为了评估 EMPD 局部治疗的临床疗效，并制定治疗指南，回顾性分析了 166 例 EMPD 患者的病历。根据既往使用的局部药物评估复发率。34 例患者（34/166，20.5%）最初接受了咪喹莫特、5-氟尿嘧啶和 ingenol mebutate 等局部药物治疗。3 例（3/34，8.8%）患者显示出临床反应，而 31 例患者因治疗失败需要后续治疗。对 166 例患者的复发预后因素进行分析，结果显示，初始局部治疗在单因素和多因素 Cox 比例风险模型中均增加了风险比（HR）（HR=3.770，95%置信区间[CI]：1.768-8.037，P=0.001，调整 HR=3.628，95%CI：1.558-8.450，P=0.003）。与未治疗组相比，接受局部治疗的患者 3 年无复发生存率明显较差（66.3% vs 88.6%，P<0.001）。局部治疗可能对某些 EMPD 患者有害，从而增加复发风险。
