Prognostic Role of the Initial Grade of Dysplasia on Premalignant Vocal Fold Lesions

• Published in: Journal of voice 2025-01, Vol.39 (1), p.238-244
• Main Authors: Viana Pinto, João, Ruas, José João, Rodrigues, João Aragão, Pinto, Isabel, Leal, Manuel, Vales, Fernando, Moura, Carla Pinto
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biopsy; Carcinoma in Situ - mortality; Carcinoma in Situ - pathology; Carcinoma, Squamous Cell - mortality; Carcinoma, Squamous Cell - pathology; Disease Progression; Dysplasia; Female; Humans; Laryngeal cancer; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - pathology; Laryngology; Laryngoscopy; Male; Middle Aged; Precancerous Conditions - mortality; Precancerous Conditions - pathology; Progression-Free Survival; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Vocal Cords - pathology; Vocal Cords - physiopathology; Vocal fold
• ISSN: 0892-1997; 1873-4588; 1873-4588
• DOI: 10.1016/j.jvoice.2022.07.015

The main objective of this study was to analyze the prognostic role of the initial grade of dysplasia on the progression to SCC. Retrospective cohort. This study was performed in the Otorhinolaryngology Department of a tertiary hospital center from January 2010 to December 2020. Every patient submitted to a microlaryngoscopy during this period with a histology of dysplasia on the first biopsy was included. A total of 112 patients were included and median follow-up was 24 months (range 1–120 months). Mean age at diagnosis was 59.71 (+/- 12.03) and 88 patients were male (78.6%). Initial grade of dysplasia was mild on 60 patients (53.6%), moderate on 24 (21.4%), severe on 18 (16.1%), and carcinoma in situ in 10 (8.9%). Overall, 25 patients (21.4%) developed invasive squamous cell carcinoma (SCC) and 15 (13.4%) died during follow-up. On an adjusted 5 year's progression free survival analysis, considering gender, age, dysplasia grade, tobacco and alcohol consumption, the initial grade of dysplasia was the only factor significantly associated with progression to carcinoma (P = .047). When compared to mild dysplasia, moderate dysplasia had a Hazard Ratio (HR) of 0.81 (95%CI 0.21–3.22); severe dysplasia had a HR of 1.76 (95%CI 0.59–5.30) and carcinoma in situ had a HR of 4.25 (95%CI 1.44–12.59). The initial dysplasia grade seems to be the most important prognostic factor regarding progression to SCC in patients with premalignant vocal fold disease.