Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
Laryngoscope. 2010 Apr;120(4):698-702. doi: 10.1002/lary.20785.
OBJECTIVES/HYPOTHESIS: Recurrent respiratory papillomatosis (RRP) is a benign disease characterized by recurrent lesions in the airway. The prevalence and degree of dysplasia that is present in the natural course of RRP is not well established. Adjuvant therapies, such as cidofovir, have been tried with the goal of decreasing the interval between repeat surgical treatments, the mainstay of therapy. Although, the off-label use of cidofovir to treat RRP has been common, there have been concerns regarding carcinogenic transformation following the use of cidofovir. This study aims to explore the association between increasing degree of papilloma dysplasia and the use of cidofovir in the context of the natural progression of dysplasia in RRP.
Retrospective case series.
Demographic data and surgical history were obtained through chart reviews for this retrospective case series of 13 patients with RRP who had histopathologic biopsies done before and after exposure to cidofovir. Pathologic data collected over 10 years from serial excisions at the University of Iowa Hospitals were reviewed by a single pathologist, and the highest degree of dysplasia was noted per excision time.
Of the 176 specimens collected in these 13 patients with serial papilloma biopsies, 5.7% had no dysplasia, 57.4% had mild dysplasia (grade 1), 28.4% had moderate dysplasia (grade 2), and 8.5% had severe dysplasia (grade 3). A comparison of each patient's multiple biopsies across time suggested that the dysplastic grade was worse in two patients, better in four patients, and virtually unchanged in seven patients. There was no clear-cut pattern between the use of cidofovir and the degree of dysplasia over time.
These results strongly suggest that intralesional cidofovir therapy does not correlate with worsening dysplastic progression. Dysplasia is relatively common in the setting of RRP; however, the prognostic significance of this finding is unknown. Additional research is needed to delineate the natural progression of dysplasia and its clinical significance in RRP, as well as the efficacy of cidofovir.
目的/假设：复发性呼吸道乳头瘤病（RRP）是一种以气道内复发性病变为特征的良性疾病。RRP 自然病程中存在的异型增生的患病率和程度尚未得到充分确立。已经尝试了辅助治疗，例如更昔洛韦，目的是减少重复手术治疗的间隔，这是治疗的主要方法。尽管更昔洛韦的非适应证用于治疗 RRP 已经很常见，但人们一直担心使用更昔洛韦后会发生癌变。本研究旨在探讨在 RRP 异型增生的自然进展背景下，乳头状瘤异型增生程度的增加与更昔洛韦的使用之间的关系。
回顾性病例系列。
通过对在爱荷华大学医院接受过更昔洛韦治疗前后进行组织病理学活检的 13 例 RRP 患者的病历回顾，获得了人口统计学数据和手术史。由一位病理学家对来自爱荷华大学医院的 10 年时间内连续切除的病理数据进行了回顾，按切除时间记录了每个切除标本的最高异型增生程度。
在这 13 例接受连续乳头状瘤活检的患者中，共采集了 176 个标本，其中 5.7%无异型增生，57.4%为轻度异型增生（1 级），28.4%为中度异型增生（2 级），8.5%为重度异型增生（3 级）。对每位患者多次活检的时间进行比较，发现有 2 名患者的异型增生程度加重，4 名患者的异型增生程度减轻，7 名患者的异型增生程度基本不变。在时间上，使用更昔洛韦与异型增生程度之间没有明显的模式。
这些结果强烈表明，病灶内更昔洛韦治疗与异型增生进展恶化无关。在 RRP 中，异型增生较为常见；然而，目前尚不清楚这一发现的预后意义。需要进一步研究来阐明 RRP 中异型增生的自然进展及其临床意义，以及更昔洛韦的疗效。
