Supplementary Material for: Efficacy of Photodynamic Therapy for the Treatment of Bowen’s Disease: A Meta-Analysis of Randomized Controlled Trials

<b><i>Background:</i></b> Photodynamic therapy is an established treatment option for Bowen’s disease. Our meta-analysis was aimed at evaluating the efficacy and recurrence of photodynamic therapy or other topical treatments (5-fluorouracil, cryotherapy) and of photodynamic therapy alone or in combination with other therapies (ablative fractional CO₂ laser or plum-blossom needle) for the treatment of Bowen’s disease. <b><i>Methods:</i></b> Trials that met our inclusion criteria were identified from PubMed, EMBASE, Web of Science, and Cochrane Library databases, and meta-analyses were conducted with RevMan V.5.4. The risk of bias was estimated with the Cochrane Collaboration’s risk of bias tools. Complete response rate, recurrence, pain/visual analogue scale score, cosmetic outcome, and adverse events were considered as outcomes. <b><i>Results:</i></b> Of the 2,439 records initially retrieved, 8 randomized controlled trials were included in this meta-analysis. According to our analyses, photodynamic therapy exhibited a significantly higher complete response rate (RR = 1.36, 95% CI [1.01, 1.84], <i>I</i>² = 86%, <i>p</i> = 0.04), less recurrence (RR = 0.53, 95% CI [0.30, 0.95], <i>I</i>² = 0%, <i>p</i> = 0.03), and better cosmetic outcome (RR = 1.34, 95% CI [1.15, 1.56], <i>I</i>² = 0%, <i>p</i> = 0.0002) compared with other treatments. Moreover, there was a significant difference between the complete response rate of photodynamic therapy combined with ablative fractional CO₂ laser and that of photodynamic therapy (RR = 1.85, 95% CI [1.38, 2.49], <i>I</i>² = 0%, <i>p</i> &lt; 0.0001). Photodynamic therapy combined with ablative fractional CO₂ laser or plum-blossom needle also showed significantly less recurrence (RR = 0.21, 95% CI [0.09, 0.51], <i>I</i>² = 0%, <i>p</i> = 0.0005) and a lower visual analogue scale score (RR = 0.51, 95% CI [0.06, 0.96], <i>I</i>² = 0%, <i>p</i> = 0.03) than photodynamic therapy alone. However, there was no significant difference in the complete response rate between photodynamic therapy combined with ablative continuous CO₂ laser and photodynamic therapy combined with ablative fractional CO₂ laser (RR = 1.00, 95% CI [0.54, 1.86], <i>I</i>² not applicable, <i>p</i> = 1.00). <b><i>Conclusions:</i></b> This meta-analysis shows that photodynamic therapy can be used in the treatment of Bowen’s disease with better efficacy, less recurrence, and better cosmetic outcomes than cryotherapy and 5-FU. Some methods, including ablative fractional CO₂ laser, can be applied in combination with photodynamic therapy to improve efficacy. However, which laser-assisted photodynamic therapy scheme has the most advantages in the treatment of Bowen’s disease warrants further exploration.

**背景：** 光动力疗法（Photodynamic therapy）是治疗鲍温病的成熟方案。本荟萃分析旨在评估光动力疗法单独使用、联合其他局部治疗手段（5-氟尿嘧啶（5-fluorouracil）、冷冻疗法），或联合其他疗法（剥脱性点阵CO₂激光（ablative fractional CO₂ laser）、梅花针（plum-blossom needle））治疗鲍温病的疗效与复发情况。
**方法：** 从PubMed、EMBASE、Web of Science及考克兰图书馆（Cochrane Library）数据库中筛选符合纳入标准的试验，采用RevMan V.5.4软件进行荟萃分析。使用考克兰协作网偏倚风险评估工具评价纳入研究的偏倚风险。本研究的结局指标包括完全缓解率、复发率、疼痛视觉模拟评分、美容结局及不良事件。
**结果：** 初始检索共获得2439条记录，最终纳入8项随机对照试验。分析结果显示，相较于其他治疗手段，光动力疗法的完全缓解率显著更高（相对风险RR=1.36，95%置信区间CI[1.01, 1.84]，I²=86%，P=0.04），复发率更低（RR=0.53，95%CI[0.30, 0.95]，I²=0%，P=0.03），且美容结局更优（RR=1.34，95%CI[1.15, 1.56]，I²=0%，P=0.0002）。此外，光动力疗法联合剥脱性点阵CO₂激光组的完全缓解率显著高于单纯光动力疗法组（RR=1.85，95%CI[1.38, 2.49]，I²=0%，P<0.0001）。相较于单纯光动力疗法，光动力疗法联合剥脱性点阵CO₂激光或梅花针可显著降低复发率（RR=0.21，95%CI[0.09, 0.51]，I²=0%，P=0.0005），并降低疼痛视觉模拟评分（RR=0.51，95%CI[0.06, 0.96]，I²=0%，P=0.03）。但光动力疗法联合剥脱性连续型CO₂激光组与联合剥脱性点阵CO₂激光组的完全缓解率无显著差异（RR=1.00，95%CI[0.54, 1.86]，I²值不适用，P=1.00）。
**结论：** 本荟萃分析表明，相较于冷冻疗法与5-氟尿嘧啶，光动力疗法治疗鲍温病的疗效更优、复发率更低且美容结局更佳。部分干预手段（如剥脱性点阵CO₂激光）可与光动力疗法联合使用以提升治疗效果。但目前哪种激光辅助光动力疗法方案在鲍温病治疗中优势最为显著，仍有待进一步探索。