Incidence and malignant transformation of glottic precursor lesions in Denmark

Abstract

Objectives: Glottic precursor lesion (GPL) is a well-known premalignant condition, but the existing knowledge of incidence and malignant potential is based on subpopulation studies. In this first nationwide study we report data from all verified cases of GPL in Denmark during a 10-year period with focus on incidence and malignant transformation of GPL.Methods: Patients were identified by a search for GPL in the time period from 01.01.2000 to 31.12.2009 using the Danish Pathology Data Base, Patobank, which is a nationwide source of all cyto-and histopathological data obtained in Denmark. Data were validated and supplemented by medical chart review.Results: A 10-year national cohort of 965 patients (median age 60 years, male-female ratio 2:1) with histologically verified GPL was analyzed. The overall malignant transformation rate was 18.3 % (mild dysplasia 7.7%, moderate dysplasia 19.8%, severe dysplasia 28.5%, and carcinoma in situ 40.3%) with a median progression time of 29 months. Eighty-eight percent of patients were active or former smokers. A significantly larger proportion of male patients (24.1 %) experienced malignant transformation compared to females (6.6%) (p<0.001). Conclusion:This nationwide population-based study of GPL patients confirmed a stable incidence of GPL in Denmark from January 2000 to December 2009 and a considerable malignant potential, correlated to the grading of GPL according to the World Health Organization classification of laryngeal precursor lesions from 2005, WHOC2005. The recent update, WHOC2017, of low-grade versus high-grade lesions may thus contain less nuanced prognostic information than WHOC2005.

Malignant Transformation of Dysplastic Vocal Fold Lesions

“…A total of 18 articles with 3243 participants were included in the final systematic review, and all of these were included in the meta-analysis. [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Study characteristics are shown in Table 1.…”

“…With regard to time to malignant transformation, only 7 of the included studies provided data for this outcome. 21,24,26,28,31,32,34 These studies were combined to calculate the weighted mean time to transformation, which was determined to be 28.8 months (range, 22.0-35.6 months) for all dysplasia grades.…”

“…A total of 17 studies were combined to assess the odds of malignant transformation of moderately dysplastic lesions com- pared with mildly dysplastic lesions, resulting in 640 cases of moderate dysplasia and 1032 cases of mild dysplasia (Figure 2A). [19][20][21][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Data synthesis showed that moderately dysplastic lesions had higher odds of undergoing malignant transformation compared with mildly dysplastic lesions (OR, 2.90; 95% CI, 2.06-4.09). The I 2 statistic was 0%, which indicated a low level of heterogeneity among the studies.…”

“…Similarly, 17 studies were combined to assess the odds of malignant transformation of severely dysplastic lesions compared with mildly dysplastic lesions (Figure 2B). [19][20][21][22][23][24][25][26][28][29][30][31][32][33][34][35][36] This resulted in 630 cases of severe dysplasia and 1038 cases of mild dysplasia. Severely dysplastic lesions showed significantly higher odds of malignant transformation compared with mildly dysplastic lesions (OR, 3.42; 95% CI, 2.11-5.52).…”

Laryngeal dysplasia: a 10-year review of rates of progression to invasive carcinoma and treatment-specific outcomes in a regional ENT department in Northern Ireland

“…[12][13][14] A study by Sannino et al demonstrated that rates of progression to carcinoma for mild and moderate grades of laryngeal dysplasia were 7.7 per cent and 19.8 per cent, respectively. 15 This raised concerns that the treatment and need for follow up of the newly termed 'low-grade lesions' would be crudely underestimated.…”