Petzold Anne, Wessely Anja, Steeb Theresa, Berking Carola, Heppt Markus V
Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
Comprehensive Cancer Center Erlangen - European Metropolitan Area of Nuremberg (CCC ER-EMN), Erlangen, Germany.
J Eur Acad Dermatol Venereol. 2025 Mar;39(3):543-554. doi: 10.1111/jdv.20267. Epub 2024 Aug 16.
Cutaneous squamous cell carcinoma in situ (Bowen's disease) is a precancerous condition confined to the epidermis of the skin. Despite the critical need for effective interventions to halt its progression, there remains a notable shortage of comprehensive data comparing the efficacy of various therapeutic approaches.
This systematic review and meta-analysis endeavour to compare the different efficacies of interventions by investigating and synthesizing data from numerous trials.
A pre-defined protocol was registered in PROSPERO (CRD42021242224, registration date: 16 April 2021). Systematic searches in Medline, Embase and Central, along with manual trial register searches, identified studies reporting lesion clearance rates (LCR), participant clearance rates (PCR) or recurrence rates (date of last search: 12 June 2024). Quality assessment followed guidelines from the National Heart, Lung, and Blood Institute (NHLBI). After the study arms were categorized into treatment groups and groups of study quality, the proportions were pooled using the generalized linear mixed model (GLMM) as meta-analytical method.
A comprehensive inclusion of 71 studies facilitated an evaluation of 3783 lesions for LCR, 1225 patients for PCR, 4073 lesions for lesion recurrence rates (LRR) and 740 patients for participant recurrence rates (PRR). Surgery demonstrated the highest LCR and PCR (0.97, 95% confidence interval (CI): 0.90-0.99) and the lowest LRR (0.04, 95% CI: 0.02-0.07).
This study provides a thorough overview of reported efficacy outcomes for practice-relevant interventions for Bowen's disease. Surgery outperformed other treatments for Bowen's disease. For the other intervention groups, it was not possible to show clear differences in effectiveness: LCR, PCR, LRR and PRR showed various treatment rankings, and the comparability was restricted by different numbers of studies between treatment groups and outcome measures, methodical and clinical heterogeneity. Further high-quality studies are needed to investigate practice-relevant interventions for Bowen's disease.
皮肤原位鳞状细胞癌（鲍温病）是一种局限于皮肤表皮的癌前病变。尽管迫切需要有效的干预措施来阻止其进展，但比较各种治疗方法疗效的全面数据仍然明显不足。
本系统评价和荟萃分析旨在通过调查和综合众多试验的数据，比较不同干预措施的疗效。
在PROSPERO（CRD42021242224，注册日期：2021年4月16日）注册了预定义方案。在Medline、Embase和Central进行系统检索，并手动检索试验注册库，以确定报告病变清除率（LCR）、参与者清除率（PCR）或复发率的研究（最后检索日期：2024年6月12日）。质量评估遵循美国国立心肺血液研究所（NHLBI）的指南。在将研究组分为治疗组和研究质量组后，使用广义线性混合模型（GLMM）作为荟萃分析方法汇总比例。
全面纳入71项研究有助于评估LCR的3783个病变、PCR的1225名患者、病变复发率（LRR）的4073个病变和参与者复发率（PRR）的740名患者。手术显示出最高的LCR和PCR（0.97，95%置信区间（CI）：0.90-0.99）和最低的LRR（0.04，95%CI：0.02-0.07）。
本研究全面概述了鲍温病相关实践干预措施的报告疗效结果。手术治疗鲍温病的效果优于其他治疗方法。对于其他干预组，无法显示出明显的疗效差异：LCR、PCR、LRR和PRR显示出不同的治疗排名，且可比性受到治疗组和结局指标之间研究数量不同、方法学和临床异质性的限制。需要进一步开展高质量研究来调查鲍温病的相关实践干预措施。
