A Network Meta‐Analysis of Non‐Melanoma Skin Cancer (NMSC) Treatments: Efficacy and Safety Assessment

Abstract

The mainstream treatments for non-melanoma skin cancer (NMSC) include photodynamic therapy (PDT), surgery excision (SE), cryotherapy (CT), imiquimod (IM), radiotherapy (RT), 5-fluorouracil (FU), and vehicle (VE). Our network meta-analysis (NMA) was aimed at evaluating the efficacy and safety of these seven treatments and providing superior ones. After searching the trials from Embase and PubMed and screening with our criteria, we conducted the NMA with software R 3.2.3 and STATA 13.0. Complete lesion response (CLR), complete lesion clearance (CLC), cumulative recurrence probabilities (CRP), and adverse effects (AEs) were considered as outcomes and displayed as odds ratios (ORs) and 95% credible intervals (CrI). The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment on each index. The consistency of direct and indirect evidence was also assessed by node-splitting and heat plot methods. Data from 18 trials with 3706 patients were included. Both IM and SE were demonstrated significantly higher CLR rate than VE (OR = 9.12, 95% CrI = 1.92-47.5; OR = 26.1, 95% CrI = 1.92-347; respectively), while only IM was proved to be statistically better than VE in CLC rate (OR = 7.03, 95% CrI = 1.51-32.8). No significant difference was observed concerning CRP, and IM was more likely to induce AEs than VE (OR = 4.44, 95% CrI = 1.58-13.9). The SUCRA results indicated that SE was the treatment with best ranking in the entire three efficacy indexes and a relatively high safety. Taking efficacy and safety into account, our study recommended SE as the optimal regimen for NMSC with high efficacy considering CLR, CLC, and CRP and moderate AEs when compared with other interventions. J. Cell. Biochem. 118: 3686-3695, 2017. © 2017 Wiley Periodicals, Inc.

Keratinocyte carcinoma as a chronic disease in Australia and Spain: The importance of avoidance of perceived visible scars

“…Although the literature suggests female gender correlates with poorer HRQL, our study found no correlation. Younger age (<50 years) has been a predictor of poorer HRQL in prior validation of the SCI, yet this correlation was only weakly associated across the emotional domain in bivariate and multivariate analysis …”

“…Keratinocyte carcinomas were predominately managed surgically in the Spanish population. This may reflect lower incidence and implementation of tissue‐sparing methods given surgical excision has historically been favoured regarding clearance and cure . However, in an increasingly patient‐oriented health‐care system, non‐surgical means (when amenable) should be considered and scar size and location should be prioritised as secondary outcomes following curative treatment.…”

Updates on the Management of Non-Melanoma Skin Cancer (NMSC)

“…NMSCs are considered curable diseases and the treatment mostly comprises of lesion removal. In addition, systemic and topical pharmacotherapy, cryotherapy (CT), photodynamic therapy (PDT), laser, and radiotherapy (RT) are also used [ 109 , 110 , 111 , 112 , 113 ]. A variety of techniques may be employed when removing NMSC.…”

Surgery is the first line treatment in the management of non-melanoma skin cancers

“…Ez a technika megbízható sebészi ellátást biztosít szövetkímélő módon, elfogadható gyorsasággal és kiemelkedő költséghatékonysággal (19). Egy közelmúltban megjelent meta-analysis eredményei szerint a daganat teljes eltávolítása, és a recidiva arányok tekintetében sebészi kimetszéssel sokkal jobb eredményeket lehet elérni, mint a nem sebészeti eljárásokkal (cryoterápia, fotodinámiás terápia, rtg kezelés, 5-flurouracil, és imiquimod terápia (23).…”