Bayan Semirra, Faquin William C, Zeitels Steven M
1 Department of Otolaryngology-Head and Neck Surgery, University of Chicago Medicine, Chicago, IL, USA.
2 Department of Pathology, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA.
Ann Otol Rhinol Laryngol. 2019 Mar;128(3_suppl):25S-32S. doi: 10.1177/0003489418818852.
: Recent reported evidence indicates that vocal cord carcinoma is evolving similarly to oropharyngeal cancer with an increasing number of patients without a smoking history having human papillomavirus (HPV) disease. Observations also suggest that an increasing number of patients who present with glottic carcinoma are younger than has been reported in the past. Therefore, an investigation was done to examine the incidence of glottic carcinoma in patients 30 years old (y/o) or younger.
: A retrospective review was done with Institutional Review Board approval to evaluate the incidence of patients 30 y/o or younger presenting with glottic carcinoma in 2 symmetric-length time periods over 28 years. These data were comprised from glottic cancer patients evaluated by the senior author (S.M.Z.) at the Massachusetts Eye and Ear Infirmary (July 1990-June 2004) and subsequently at the Massachusetts General Hospital (July 2004-June 2018). HPV testing was done on those patients identified as having a disease process at 30 y/o or younger.
: Between July 1990 and June 2018, 353 patients were diagnosed with glottic carcinoma. From July 1990 to June 2004, there were 112 patients, with none being 30 y/o or younger. From July 2004 to June 2018, 241 patients were diagnosed with glottic carcinoma; 11 patients (7 females, 4 males) were 30 y/o or younger. Of the 11 patients, 3 (1 female, 2 males) were 10 to 19 y/o, 3 (2 females, 1 male) were 20 to 25 y/o, and 5 (4 females, 1 male) were 26 to 30 y/o. Moreover, 10 of the 11 cases were tested and were positive for high-risk HPV. None of the 11 glottic cancer patients had been previously treated for benign recurrent respiratory papillomatosis although it was initially suspected prior to biopsy due to the morphology of the lesions and the patients' young age. Three of 11 had a history of smoking; all 3 had less than 3 pack-years. One of the 11 glottic cancer patients was treated with serial Cidofovir injections that resulted in dramatic acceleration in the growth of the cancer.
: Historically, glottic carcinoma is considered to be a tobacco-induced disease associated with a multidecade process of initiation, promotion, transformation, and progression. However, recent published evidence shows that glottic carcinoma can be an HPV-related disease with increasing incidence in nonsmokers. It isn't surprising that alternate malignant pathways may have a different timeline. In this investigation, an increased incidence of HPV-positive glottic cancer in patients 30 y/o or younger was documented in the past 14 years. This finding further supports the concept that glottic carcinoma is an evolving disease, and it demonstrates the increasing importance of discriminating potential glottic carcinomas in young patients from benign low-risk HPV recurrent respiratory papillomatosis.
最近报道的证据表明，声带癌正与口咽癌呈现相似的演变趋势，越来越多无吸烟史的患者感染人乳头瘤病毒（HPV）。观察结果还显示，出现声门癌的患者年龄比过去报道的更年轻。因此，开展了一项调查，以研究30岁及以下患者声门癌的发病率。
在获得机构审查委员会批准后进行了一项回顾性研究，以评估28年中两个等长时间段内30岁及以下声门癌患者的发病率。这些数据来自资深作者（S.M.Z.）在马萨诸塞州眼耳医院（1990年7月至2004年6月）以及随后在马萨诸塞州总医院（2004年7月至2018年6月）评估的声门癌患者。对那些被确定为30岁及以下患有疾病的患者进行了HPV检测。
1990年7月至2018年6月期间，353例患者被诊断为声门癌。1990年7月至2004年6月，有112例患者，其中没有30岁及以下的患者。2004年7月至2018年6月，241例患者被诊断为声门癌；11例患者（7名女性，4名男性）为30岁及以下。在这11例患者中，3例（1名女性，2名男性）年龄在10至19岁之间，3例（2名女性，1名男性）年龄在20至25岁之间，5例（4名女性，1名男性）年龄在26至30岁之间。此外，11例病例中的10例进行了检测，高危HPV呈阳性。11例声门癌患者均未接受过良性复发性呼吸道乳头状瘤病的治疗，尽管由于病变形态和患者年龄较小，活检前最初怀疑有该病。11例中有3例有吸烟史；所有3例的吸烟包年数均少于3年。11例声门癌患者中有1例接受了西多福韦系列注射治疗，导致癌症生长显著加速。
从历史上看，声门癌被认为是一种与数十年的起始、促进、转化和进展过程相关的烟草诱发疾病。然而，最近发表的证据表明，声门癌可能是一种与HPV相关的疾病，在非吸烟者中的发病率不断上升。替代的恶性途径可能有不同的时间线并不奇怪。在这项调查中，记录了过去14年中30岁及以下患者HPV阳性声门癌的发病率增加。这一发现进一步支持了声门癌是一种不断演变的疾病的概念，并且它表明了区分年轻患者潜在声门癌与良性低风险HPV复发性呼吸道乳头状瘤病的重要性日益增加。
