Page 93 - Revista Portuguesa - SPORL - Vol 60. Nº3
P. 93
with a Hazard Ratio (HR) of 4,09 (p<0,001) and controversial . In fact, a previous systematic
14
patients with more than 65 years old, with a review showed that the rates of progression
HR of 4,90 (p<0,001) . The lack of association reported in the literature for different grades
9
in this study could have occurred due to a of dysplasia were highly variable, and it wasn’t
smaller sample size. possible to reach a conclusion regarding
Even though tobacco and alcohol the role of the initial grade of dysplasia on
consumption are traditionally acknowledged malignancy rates . Furthermore, while some
15
as the most important risk factors for studies show that more severe grades of
laryngeal cancer , a meta-analysis has dysplasia are associated with higher rates of
10
concluded the data presented in previous progression to carcinoma 4,7,11 , others report
studies regarding the role of alcohol and no association 8,16 . The present study supports
tobacco on progression of dysplastic vocal an association of the initial grade of dysplasia
fold lesions to cancer was insufficient . In with malignant transformation.
11
the present study, tobacco and alcohol This study has several limitations. Firstly, it is
consumption or smoking cessation weren’t a retrospective observational study which
associated with malignization in patients can lead to information bias. Furthermore,
with leucoplakia. Furthermore, Theodosiu surgeries were performed by different
et al reported that smoking cessation after surgeons and biopsies were analysed by
diagnosis didn’t affect the progression rates of different pathologists. On the other hand, this
pre-malignant vocal fold lesions but the time allows for a more realistic approximation to
to malignant transformation was higher in clinical practice in most hospitals. Lastly, the
patients that stopped smoking (31,5 months) subjective WHO 2005 system was used to
when compared to patients that didn’t (19,5 classify different dysplasia grades, which has
months) . been updated in 2017. This WHO 2017 system
12
GERD wasn’t associated with malignization acknowledges two different categories: low
in this population of patients with vocal grade dysplasia (which includes the previous
leucoplakia as previously reported . On the hyperplasia, mild dysplasia and moderate
7
other hand, Yang et al found that vocal fold dysplasia involving up to half of the epithelium)
leucoplakia recurred more often in patients and high grade dysplasia (including moderate
with GERD, with an Odds Ratio (OR) of 8,43 dysplasia involving more than half of the
in a multivariate analysis adjusted to smoking epithelium, severe dysplasia and carcinoma
and alcohol consumption . Thus, even though in situ) . Lastly, since many patients missed
17
13
leucoplakia seems to recur more often in follow-up appointments, median follow-up
patients with GERD, it doesn’t seem to be was only 24 (8 - 43,5) months.
associated with a higher risk of progression to
malignant squamous cell carcinoma. Conclusion
In this study, the only factor significantly Vocal fold leucoplakia should always be
associated with progression to SCC was submitted to a biopsy since they can be pre-
the initial histological grade. Even when malignant or malignant in an important
only pre-malignant lesions were taken into number of the cases. In non-malignant vocal
account, the initial histological grade was fold leucoplakia, the most important risk
still the only factor significantly associated. factor for progression to carcinoma seems to
Although it is universally believed that more be the initial histological grade.
severe grades of dysplasia are associated with
higher malignization rates, the European Conflito de Interesses
Laryngological Society has stated on their Os autores declaram que não têm qualquer
2021 position paper on laryngeal dysplasia conflito de interesse relativo a este artigo.
that the data presented in the literature is
Volume 60 . Nº3 . Setembro 2022 249
