PDF(Pubmed)
Abstract：
Extramammary Paget\'s disease (EMPD) is subclinical in extent and multifocal in nature. There is no global consensus for treatment, so its management represents a challenge in clinical practice. Therefore, we conducted a systematic review through the main electronic databases to assess the effectiveness of topical imiquimod in cutaneous EMPD and to discuss its management. Finally, 24 studies involving a total of 233 EMPD patients treated with topical imiquimod were selected. The topical imiquimod response rate was 67%, and the complete response (CR) rate was 48%. Patients were treated with a three-four times a week regimen in most cases, ranging between 2 to 52 weeks. In addition, imiquimod was applied as an adjunctive treatment in 21 patients, achieving a CR rate of 71%. Consequently, imiquimod therapy could achieve a good response ratio as a first-line treatment, as adjuvant and neo-adjuvant therapy, and as a treatment for recurrent disease. The heterogeneity between studies and the lack of a control arm made it impossible to conduct a meta-analysis. To improve the quality of evidence on EMPD, multicenter studies are essential to collect a larger number of patients and, consequently, obtain high-quality evidence to standardize treatment. The Prospero registration number is CRD42023447443.
摘要：
乳腺外Paget病（EMPD）的范围为亚临床，本质上为多灶性。治疗没有全球共识，因此，它的管理是临床实践中的一个挑战。因此,我们通过主要电子数据库进行了系统评价,以评估局部用咪喹莫特在皮肤EMPD中的有效性,并讨论其治疗方法.最后,选择了24项研究，涉及总共233名使用局部咪喹莫特治疗的EMPD患者。局部咪喹莫特反应率为67%，完全缓解(CR)率为48%。在大多数情况下，患者每周接受3-4次治疗，在2到52周之间。此外,咪喹莫特作为辅助治疗21例，达到71%的CR率。因此,咪喹莫特治疗作为一线治疗可以达到良好的反应率，作为辅助和新辅助治疗，作为复发性疾病的治疗方法。研究之间的异质性和缺乏控制臂使得无法进行荟萃分析。为了提高EMPD的证据质量，多中心研究对于收集大量患者至关重要，因此,获取高质量的证据规范治疗。Prospero注册号为CRD42023447443。
