Ahmady Shima, Nelemans Patty J, Abdul Hamid Myrurgia, Demeyere Thomas B J, van Marion Arienne M W, Kelleners-Smeets Nicole W J, Mosterd Klara
Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands.
GROW School for Oncology and Reproduction, Maastricht University Medical Center, Maastricht, The Netherlands.
Dermatology. 2024;240(5-6):869-874. doi: 10.1159/000541396. Epub 2024 Sep 13.
Little is known about prognostic factors that may influence the response to non-invasive treatments of patients with Bowen's disease. The aim of this study was to identify patient and lesion characteristics that are associated with a higher risk of treatment failure after 5-fluorouracil and photodynamic therapy in Bowen's disease. The hypothesis that the thickness of the Bowen's lesion and extension along the hair follicle is associated with the risk of treatment failure after noninvasive treatment was also explored.
Data were derived from a non-inferiority randomized trial in which 169 patients were treated with 5% 5-fluorouracil cream twice daily for 4 weeks or 2 sessions of methylaminolevulinate photodynamic therapy with 1-week interval. All patients had histologically confirmed Bowen's disease of 4-40 mm. The initial 3 mm biopsy specimens were re-examined to measure the maximum histological lesion thickness and extension along the hair follicle. To evaluate the association between potential risk factors for treatment failure at 1-year follow-up, univariate and multivariate logistic regression analyses were used to calculate odds ratios (ORs) with 95% confidence intervals and p values.
Histological lesion thickness was not significantly associated with treatment failure (OR: 0.84, p = 0.806), nor was involvement of the hair follicle (OR: 1.12, p = 0.813). Lesion diameter was the only risk factor that was significantly associated with 1-year risk of treatment failure (OR = 1.08 per mm increase, p = 0.021). When using the median value of 10 mm as cut-off point, the risk of treatment failure was 23.4% for lesions >10 mm compared to 10.3% for lesions ≤10 mm (OR: 2.66, p = 0.028).
Only clinical lesion diameter was identified as a prognostic factor for response to non-invasive therapy in Bowen's disease.
关于可能影响鲍恩病患者非侵入性治疗反应的预后因素，人们了解甚少。本研究的目的是确定与鲍恩病患者在接受5-氟尿嘧啶和光动力治疗后治疗失败风险较高相关的患者和病变特征。我们还探讨了鲍恩病病变厚度以及沿毛囊扩展与非侵入性治疗后治疗失败风险相关的假设。
数据来自一项非劣效性随机试验，169例患者接受每日两次5% 5-氟尿嘧啶乳膏治疗，持续4周，或接受2次间隔1周的甲基氨基酮戊酸光动力治疗。所有患者经组织学确诊为4 - 40毫米的鲍恩病。重新检查最初的3毫米活检标本，以测量最大组织学病变厚度以及沿毛囊的扩展情况。为评估1年随访时治疗失败的潜在风险因素之间的关联，采用单因素和多因素逻辑回归分析来计算比值比（OR）及95%置信区间和p值。
组织学病变厚度与治疗失败无显著关联（OR：0.84，p = 0.806），毛囊受累情况也无显著关联（OR：1.12，p = 0.813）。病变直径是唯一与1年治疗失败风险显著相关的危险因素（每增加1毫米，OR = 1.08，p = 0.021）。以10毫米的中位数作为分界点，病变>10毫米的治疗失败风险为23.4%，而病变≤10毫米的治疗失败风险为10.3%（OR：2.66，p = 0.028）。
在鲍恩病中，仅临床病变直径被确定为非侵入性治疗反应的预后因素。
