Key Points:
- The onset age of RRP showed a bimodal distribution (2-6 and 26-30
years old).
- Men are more likely to develop AO-RRP.
- JO-RRP patients had higher Derkay score, higher surgical frequency and
shorter surgical interval. AO-RRP showed a higher proportion of
dysplasia (72.4%) and the risk of cancer (2.8%).
- The surgical intervals lengthened with age and shortened with higher
Derkay scores.
- Microdebrider is most commonly used, and CO2 laser surgery has the
longest surgical interval for JO-RRP patients.
Introduction
Recurrent respiratory
papillomatosis (RRP) is a benign tumor that occurs in the respiratory
tract[1] .At present, patients are usually divided
into juvenile-onset recurrent respiratory papillomatosis (JO-RRP) and
adult-onset recurrent respiratory papillomatosis (AO-RRP) according to
whether they are over 18 years old, and RRP has a higher incidence in
children and men [2-4]. However, a third peak of
incidence around 64 years was discovered by cross-sectional
study[5]. In general, JO-RRP grows rapidly, and
the lesions are often multifocal, and they are prone to recurrence after
surgery[6]. Patients with AO-RRP are mostly
localized, relatively slow-growing, and according to the available
evidence, about 1-7% of cases will develop into squamous cell carcinoma[7-10]. Pulmonary involvement occurs in
approximately 3.3% of patients with juvenile laryngeal papilloma, and
papilloma formation in the lungs and airways can lead to fatal
obstructive pneumonia. In 16% of patients with lung involvement, it may
progress to pulmonary malignancy[11].
Previous research found that endotracheal intubation aggravated distal
spread, and the longer the tube carrying time, the longer the disease
time, affecting the remission rate and mortality of
patients[12, 13]. A study in Argentina of 82
patients with RRP under 16 years of age comparing the characteristics of
RRP patients with or without extralaryngeal spread found that age
younger than 5 years or history of tracheostomy at the time of diagnosis
of RRP were factors associated with extralaryngeal spread, and the
occurrence of extralaryngeal spread was also associated with HPV subtype
11 infection[14].
RRP is still mainly based on surgical treatment, the most commonly used
is microdebrider [15], CO2
laser[16] or 532nm Potassium-Titanyl-Phosphate
laser (KTP laser) [17-24]. However, surgery does
not seem to completely prevent the recurrence of the disease, and the
efficacy of a variety of existing adjuvant treatments is not clear, and
some patients often require repeated surgery. The correlation between
age of onset, lesion size, surgical mode and interval between operations
has not been fully studied. In the current studies, the lack of uniform
evaluation criteria for the description of lesion size hinders the
systematic analysis of various studies.
Materials and methods
All subjects in this study were
from cases diagnosed with RRP and underwent surgery in our hospital
between January 2016 and December 2021, and eligible case demographic
information, treatment-related information and postoperative follow-up
data were collected. We have followed STROBE Statement
(strobe-statement.org)
as the reporting guideline.
The inclusion and exclusion criteria are as follows: Part I inclusion
criteria: (1) cases with a preliminary preoperative diagnosis of
”laryngeal mass” or ”RRP” or ”benign laryngeal tumor”; (2) Have a
complete laryngoscopy report within one month before surgery, or check
the extent of lesions during surgery and have detailed records; (3) the
patient consents to surgical treatment; (4) Postoperative specimens were
sent for examination, and pathology report RRP. Exclusion criteria: (1)
postoperative loss to follow-up; (2) Those who have not operated again
after surgery and cannot calculate the interval between operations; (3)
History of surgery or radiotherapy for other pharyngeal and laryngeal
diseases during the course of RRP.
Part II Based on the first part of the study, obtain information about
each operation of JO-RRP patients, and treat each operation as a
surgical case, and screen eligible surgical cases among the study
subjects included in the first part according to the following criteria
as the study subjects of the second part. Inclusion criteria: Only a
single surgical modality, such as a microdebrider or CO2 laser or KTP
laser, was used intraoperatively. Exclusion criteria: (1) Use in
combination with adjuvant therapy; (2) Postoperative pathology suggests
malignant RRP transformation; (3) Previous history of tracheostomy
surgery; (4) Papilloma lung involvement. The study was approved by the
Ethics Committee of our institution.
Collect medical records of all
included cases and record the following information: demographic
information, including sex, age at first diagnosis (age at first
diagnosis), age at onset (age at each onset); Clinical manifestations of
the first episode: dysphonia, dyspnea, laryngeal obstruction division,
dysphagia, Derkay score[25] calculated according
to the site and size of the first lesion; Information related to
surgical treatment: including operation time, operation method,
operation interval (days), postoperative pathology report.
In the second part, the patients are treated with surgery, which is
performed by senior doctors in the Department of Nose and Throat of our
hospital. According to the surgical method, the surgical cases included
in the study were divided into three groups, namely microdebrider group,
CO2 laser group and KTP laser group. Since in the second part, each
patient undergoes at least two surgeries, and each procedure may be
different, each patient who undergoes surgery will be treated as one
surgical case, that is, each surgery will be analyzed as a study
subject. The demographic information, surgical records and postoperative
follow-up information of patients in the three treatment groups were
collected, and the operation interval (days) of the three treatment
groups was counted.
Statistics are performed using IBM SPSS Statistics26. Continuous normal
data are described by means ± standard deviation, and the difference is
tested by independent sample T. Categorical data are represented using
n(%), and differences between groups are represented using chi-square
tests or Fisher analysis. The chi-square goodness-of-fit test was used
to compare the proportion of dichotomous variables such as sex
proportion and whether dysplasia was present. The correlation between
two continuous variables was analyzed using linear correlation (the
closer the absolute value of r to 1, the stronger the correlation,
<0.3 very weak correlation, 0.3-0.5 weak correlation, 0.5-0.7
medium correlation, >0.7 strong correlation).Graph
visualization in GraphPadPrism.P<0.05 is statistically
significant.