Prospective, Multi‐Center Study of the Anatomic Distribution of Recurrent Respiratory Papillomatosis

Abstract

Objectives/Hypothesis: To create a model of the anatomic distribution, recurrence, and growth patterns of recurrent respiratory papillomatosis (RRP).Study Design: Prospective, multi-institutional cohort study.Methods: Adult patients with a diagnosis of RRP evaluated between August 1, 2018 and February 1, 2021 at six participating centers were invited to enroll. At each office or operating room encounter, laryngologists recorded the location and size of RRP lesions using a 22-region schematic. A generalized linear mixed effects model was used to compare region variations in lesion prevalence and recurrence.Results: The cohort comprised 121 patients: 74% were male, 81% had been diagnosed with adult-onset RRP, and a plurality (34%) had undergone 0 to 3 RRP interventions prior to enrollment. Across the study period, the odds of a lesion occurring in the glottis was significantly higher (odds ratio [OR]: 26.51; 95% confidence interval [CI]: 11.76-59.75, P < .001) compared with all other areas of the larynx and trachea. Within the true vocal folds, the membranous vocal folds had significantly higher odds (OR: 6.16; 95% CI: 2.66-14.30, P < .001) of lesion occurrence compared to the cartilaginous vocal folds. Despite these strong trends in lesion distribution, there were no differences in the odds of lesion recurrence, growth, or in the time to recurrence, between anatomic subsites.Conclusions: RRP lesions are most likely to occur in the glottis, particularly the membranous vocal folds, compared with other regions of the larynx or trachea. However, all lesions demonstrate similar behavior with respect to recurrence, growth, and time to recurrence regardless of anatomic location.

Association between human papillomavirus particle production and the severity of recurrent respiratory papillomatosis

“…However, looking at the L1 IHC-positive cases in this study, they tend to be positive regardless of the surgeries performed (Fig. 5A and Supplementary Table S1, Case 5,8,22,23). In addition, even short surgical intervals can occur with L1 IHC-positivity.…”

“…The HPV frequency is reportedly more than 80% based on recent papers on RRP [4][5][6] , but a few reports demonstrated an HPV involvement of approximately 60% 1,2 . Reports also exist where clinical diagnosis has been made without examining whether or not HPV is involved [7][8][9] . We examined HPV by PCR, L1 IHC, E4 IHC, and qPCR for E2/E6, all of which are undetectable in HPV-negative cases.…”

“…In general, HPV involvement is reported in 80-96.9% of patients 4-6 ; however, a few studies reported lower rate of HPV detection approximately 60% 1,2 . Moreover, some reports have not examined HPV involvement [7][8][9] . Some patients remain in remission after a single surgery, while others develop malignant transformation after multiple surgeries and have unfavourable outcomes 10,11 .…”

Safety of different surgical modalities for recurrent respiratory papillomatosis resection: A systematic review and meta‐analysis

“…The JORRP is generally more aggressive than the AORRP, with a high recurrence rate and a stronger propensity to spread 7 . RRP is characterised by recurrent papillomatous lesions that occur primarily in the larynx but occasionally involve other parts of the aerodigestive tract 8 …”

Safety of Different Surgical Modalities for Recurrent Respiratory Papillomatosis Resection: A Systematic Review and Meta-Analysis

“…The juvenile-onset RRP is generally more aggressive than the adult-onset RRP, with a high recurrence rate and a stronger propensity to spread [7] . RRP is characterized by recurrent papillomatous lesions that occur primarily in the larynx but occasionally involve other parts of the aerodigestive tract [8] .…”