Plch J, Pár I, Navrátilová I, Bláhová M, Zavadil M
ORL department Hospital Kolistì, Brno, Czech Republic.
Auris Nasus Larynx. 1998 Dec;25(4):407-12. doi: 10.1016/s0385-8146(98)00041-8.
The goal of this study was to determine subsequent malignancy on a discrete group of precancerous laryngeal lesions, and to assess the mortality. In a series of 227 patients, average age 51.8 years (ranging from 13 to 80 years). The changes were followed-up for 12.3 years (minimum of 5 years and maximum of 40 years). 58% are living without any sign of premalignant laryngeal mucosal disease, 13% with controlled precancer, and 3% in remission after surgery for carcinoma. 11% died (9% due to cause unrelated to the cancer) and 15% were lost for follow-up. 17% of the group with mucosal hyper- or metaplasia progressed to mild dysplasia, but none progressed to carcinoma. Reinke's oedema recurred in 4%, no malignancy was observed. Carcinoma developed in 16% of laryngeal papilloma (8% in situ and 8% invasive). 15% of mild dysplasia progressed in severity, but none transformed to malignancy. Moderate dysplasia progressed to severe dysplasia in 12%, carcinoma in situ in 4%. Of cases with severe dysplasia 13% developed in situ carcinoma while 43% progressed to invasive cancer. In the whole series progression to severe grade was seen in 7.1%, and malignant transformation in 4.4%. Three patients (1.3%) died due to subsequent carcinoma. Our results agree with some authors; but the majority of them reports higher incidence of malignant transformation. Invasive carcinoma was diagnosed in the follow-up in seven patients. Those represent only 3% of all laryngeal carcinomas diagnosed in our department in the same period of time. Based on the data we have evaluated the intensity of follow-up in patients with hyperplasia, metaplasia, keratosis and mild dysplasia.
本研究的目的是确定一组离散的喉癌前病变后续发生恶性肿瘤的情况，并评估死亡率。在227例患者中，平均年龄51.8岁（年龄范围为13至80岁）。对这些病变进行了12.3年的随访（最短5年，最长40年）。58%的患者存活且无喉黏膜癌前疾病迹象，13%的患者癌前病变得到控制，3%的患者在癌手术后缓解。11%的患者死亡（9%死于与癌症无关的原因），15%的患者失访。黏膜增生或化生组中有17%进展为轻度发育异常，但无进展为癌的情况。4%的患者Reinke水肿复发，未观察到恶性肿瘤。16%的喉乳头状瘤发生癌变（8%为原位癌，8%为浸润性癌）。15%的轻度发育异常病情加重，但无转变为恶性肿瘤的情况。中度发育异常有12%进展为重度发育异常，4%进展为原位癌。重度发育异常病例中，13%发生原位癌，43%进展为浸润性癌。在整个系列中，进展为重度分级的占7.1%，发生恶性转化的占4.4%。3例患者（1.3%）死于后续发生的癌症。我们的结果与一些作者一致；但他们中的大多数报告的恶性转化发生率更高。随访中诊断出7例浸润性癌。这些仅占同期在我们科室诊断的所有喉癌的3%。基于这些数据，我们评估了增生、化生、角化病和轻度发育异常患者的随访强度。
