Gallo A, de Vincentiis M, Della Rocca C, Moi R, Simonelli M, Minni A, Shaha A R
La Sapienza University, Rome, Italy.
Head Neck. 2001 Jan;23(1):42-7.
A wide spectrum of lesions ranging from dysplasia to in situ carcinoma have to be considered when dealing with laryngeal precancerous conditions. Recently the concept of laryngeal intraepithelial neoplasia (LIN) was introduced.
A series of 259 consecutive cases of laryngeal keratosis was studied from 1976 to 1994. All patients entered the study after microlaryngoscopy and biopsy. Histologic diagnoses were subdivided into keratosis without dysplasia (KWD), with mild dysplasia (LIN 1), with moderate dysplasia (LIN 2), and with severe dysplasia or carcinoma in situ (LIN 3). The follow-up period ranged from 15 months to 19 years (mean, 101 months).
KWD had the best prognosis with the lowest recurrence rate (12.5%) after stripping of laryngeal mucous membrane. The recurrence rate after stripping was higher for LIN 1 (25%) and LIN 2 cases (68.7%). The recurrence rate after CO2 laser cordectomy was 16.6% for LIN 2 and 18.7% for LIN 3. The incidence of progression to infiltrative carcinoma was 4.19% for KWD, 7.14% for LIN 1, 21.42% for LIN 2, and 9.37% for LIN 3.
KWD and LIN 1 can be successfully treated by stripping the mucous membrane, close follow-up, and a change in smoking habits. On the contrary, LIN 2 and LIN 3 need a more aggressive therapeutical approach.
在处理喉癌前病变时，必须考虑从发育异常到原位癌的广泛病变范围。最近引入了喉上皮内瘤变（LIN）的概念。
对1976年至1994年间连续的259例喉角化病病例进行了研究。所有患者均在显微喉镜检查和活检后进入研究。组织学诊断分为无发育异常的角化病（KWD）、轻度发育异常（LIN 1）、中度发育异常（LIN 2）以及重度发育异常或原位癌（LIN 3）。随访期从15个月至19年（平均101个月）。
KWD预后最佳，喉黏膜剥脱术后复发率最低（12.5%）。LIN 1（25%）和LIN 2病例（68.7%）剥脱术后复发率更高。LIN 2行CO2激光声带切除术的复发率为16.6%，LIN 3为18.7%。KWD进展为浸润性癌的发生率为4.19%，LIN 1为7.14%，LIN 2为21.42%，LIN 3为9.37%。
KWD和LIN 1可通过黏膜剥脱、密切随访和改变吸烟习惯成功治疗。相反，LIN 2和LIN 3需要更积极的治疗方法。
