Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
College of Medicine, The Ohio State University, Columbus, OH, USA.
Ann Otol Rhinol Laryngol. 2023 Nov;132(11):1380-1385. doi: 10.1177/00034894231158459. Epub 2023 Mar 6.
Recurrent respiratory papillomatosis (RRP) is a chronic disease of the upper respiratory tract caused by human papillomavirus types 6 and 11. The disease course is characteristically unpredictable, ranging from spontaneous remission to aggressive, recurrent disease. Thus, management is often challenging and requires unique approaches tailored to each individual patient. While recent literature has described risk factors for more aggressive disease, few sources have investigated the impact of smoking on RRP disease course and risk for malignant transformation.
A retrospective chart review was conducted for adult RRP patients evaluated at an academic tertiary care center between 2005 and 2020. A total of 188 patients were identified. Demographic and clinical data were collected, including smoking and alcohol history, HPV subtype, history of dysplasia and/or carcinoma, voice handicap index scores, Derkay scores, debulkings (in office and operating room), and days to papilloma recurrence.
Malignant degeneration in RRP occurred in 16.3% of smokers and 3.6% of nonsmokers. Smokers who developed carcinoma had less debulkings per years of evaluation than those not developing carcinoma (0.21 vs 0.92, = .004). Additionally, patients that either presented with or developed carcinoma during their course had a higher pack-year smoking history (18.0 vs 12.21, = .0002). No difference in days to recurrence or inter-surgical interval was demonstrated between smokers and nonsmokers.
The report demonstrates that smoking can increase the risk of malignant transformation in RRP patients.
复发性呼吸道乳头瘤病（RRP）是一种由人乳头瘤病毒 6 型和 11 型引起的上呼吸道慢性疾病。疾病过程具有不可预测性，从自发性缓解到侵袭性、复发性疾病不等。因此，管理通常具有挑战性，需要针对每个患者的独特方法。尽管最近的文献描述了更具侵袭性疾病的危险因素，但很少有研究调查吸烟对 RRP 疾病过程和恶性转化风险的影响。
对 2005 年至 2020 年间在学术三级护理中心评估的成人 RRP 患者进行了回顾性图表审查。共确定了 188 名患者。收集了人口统计学和临床数据，包括吸烟和饮酒史、HPV 亚型、发育不良和/或癌病史、嗓音障碍指数评分、德凯评分、切除术（门诊和手术室）和乳头状瘤复发天数。
RRP 恶性转化在吸烟者中的发生率为 16.3%，在非吸烟者中为 3.6%。发生癌的吸烟者每年的切除术次数少于未发生癌的吸烟者（0.21 比 0.92，= 0.004）。此外，在病程中出现或发展为癌的患者的吸烟年数更长（18.0 比 12.21，= 0.0002）。吸烟者和非吸烟者之间的复发天数或手术间隔无差异。
该报告表明，吸烟会增加 RRP 患者恶性转化的风险。
