Vokal Kord Displastik Lezyonlarında Uzun Dönem Takip Sonuçlarımız

Öz

Amaç: Bu retrospektif çalışmanın amacı, displastik larengeal lezyonlarda malign transformasyon oranı ile sürecini değerlendirmek ve elde edilen bulgularla klinik yönetim yaklaşımlarına bilimsel katkı sunmaktır. Materyal ve Metot: Patoloji sonuçları Dünya Sağlık Örgütü 2005 sınıflamasına göre hafif, orta ve yüksek derece displazi ya da karsinoma in situ (KİS) olarak raporlanan 149 hasta çalışmamıza dahil edildi. Hastalara ait sigara kullanımı, demografik veriler, lezyonların invaziv karsinoma dönüşme oranları ve takip süreleri incelendi. Bulgular: Tüm gruplarda erkek cinsiyet baskınlığı gözlendi ve daha yüksek displazi dereceleri, daha ileri yaşla ilişkili bulundu. Malign transformasyon; hafif displazide %13,9, orta displazide %33,3, ağır displazide %36,8 ve karsinoma in situ (KİS) olgularında %45,8 oranında gerçekleşti (p = 0,005). Ortalama takip süresi, hafif displazi grubuna kıyasla KİS grubunda anlamlı olarak daha uzundu. Sonuç: Hafif dereceli displastik lezyonlar dahi olsa malign transformasyon riskinin hala var olduğu, özellikle yüksek dereceli displazi ve in situ karsinom varlığında invaziv karsinom gelişme riskinin daha yüksek oranda olabileceği akılda tutulmalıdır.

Anahtar Kelimeler

• Displazi
• karsinoma in-situ
• larenks
• vokal kord

Long-Term Follow-Up Results of Dysplastic Lesions of the Vocal Cords

Öz

Objective: This retrospective study aimed to evaluate the risk and timing of malignant transformation in dysplastic laryngeal lesions, thereby contributing to clinical management. Materials and Methods: A total of 149 patients whose pathology results were reported according to the 2005 World Health Organization classification as mild, moderate, or severe dysplasia, or carcinoma in situ (CIS), were included in the study. Demographic information, smoking habits, follow-up period, and the rates of lesion progression to invasive carcinoma were recorded and analyzed. Results: Male predominance was observed across all groups, with older age associated with higher dysplasia grades. Malignant transformation occurred in 13.9% of mild, 33.3% of moderate, 36.8% of severe dysplasia, and 45.8% of CIS cases (p = 0.005). The mean follow-up period was significantly longer in the CIS group than in the mild dysplasia group. Conclusions: Although lesions with mild dysplasia retain a potential for malignant transformation, the risk of progression to invasive carcinoma is significantly elevated in the presence of severe dysplasia or carcinoma in situ.

Anahtar Kelimeler

• Carcinoma in situ
• dysplasia
• larynx
• vocal cord

Kaynakça

1. Horton G, Philteos J, Lin RJ. Malignant Transformation of Dysplastic Vocal Fold Lesions: A Systematic Review and Meta-Analysis. JAMA Otolaryngol Head Neck Surg. 2024;150(7):556-563. doi:10.1001/jamaoto.2024.1008
2. Nerurkar NK, Shah GK. A 6-Year Retrospective Study of the Demographics of Glottic Keratosis in a Tertiary Care Voice Centre. Indian J Otolaryngol Head Neck Surg. 2023;75(1):145-150. doi:10.1007/s12070-022-03279-8
3. Donaldson G, McCadden L, Napier S, Tan TJ. 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. J Laryngol Otol. 2022;136(6):547-553. doi:10.1017/S0022215122000366
4. Alex RA, Mathews SS, Paul RR, Albert RRA. Laryngeal Dysplasia: To Biopsy or Not?. Indian J Otolaryngol Head Neck Surg. 2022;74(Suppl 2):2331-2333. doi:10.1007/s12070-020-02161-9
5. Gale N, Cardesa A, Hernandez-Prera JC, Slootweg PJ, Wenig BM, Zidar N. Laryngeal Dysplasia: Persisting Dilemmas, Disagreements and Unsolved Problems-A Short Review. Head Neck Pathol. 2020;14(4):1046-1051. doi:10.1007/s12105-020-01149-9
6. Hellquist H, Ferlito A, Mäkitie AA, et al. Developing Classifications of Laryngeal Dysplasia: The Historical Basis. Adv Ther. 2020;37(6):2667-2677. doi:10.1007/s12325-020-01348-4
7. Doğan E, Boran C, Cevizci MC, Sarıoğlu S. Comparison of the prognoses of laryngeal preneoplastic lesions based on Ljubljana and World Health Organization classifications. Turk J Med Sci. 2023;53(1):396-404. doi:10.55730/1300-0144.5596
8. Eckel HE, Simo R, Quer M, et al. European Laryngological Society position paper on laryngeal dysplasia Part II: diagnosis, treatment, and follow-up. Eur Arch Otorhinolaryngol. 2021;278(6):1723-1732. doi:10.1007/s00405-020-06406-9

9. Odell E, Eckel HE, Simo R, et al. European Laryngological Society position paper on laryngeal dysplasia Part I: aetiology and pathological classification. Eur Arch Otorhinolaryngol. 2021;278(6):1717-1722. doi:10.1007/s00405-020-06403-y
10. Olson C, Alexander R, Stinnett S. Dysplastic Lesions of the Larynx. Otolaryngol Clin North Am. 2023;56(2):233-246. doi:10.1016/j.otc.2023.01.001
11. Krutz M, Acharya P, Elliott J, Zhao D, Mhawej R, Queimado L. Tobacco Cessation Following Laryngeal Cancer Diagnosis Predicts Response to Treatment and Laryngectomy-Free Survival. Otolaryngol Head Neck Surg. 2024;170(2):438-446. doi:10.1002/ohn.567
12. Khalifeh M, Ginex P, Boffetta P. Reduction of head and neck cancer risk following smoking cessation: a systematic review and meta-analysis. BMJ Open. 2024;14(8): e074723. doi:10.1136/bmjopen-2023-074723
13. Sannino NJB, Mehlum CS, Grøntved ÅM, et al. Incidence and malignant transformation of glottic precursor lesions in Denmark. Acta Oncol. 2020;59(5):596-602. doi:10.1080/0284186X.2020.1730437
14. Mueller-Diesing F, Stöth M, Ludwig E, et al. Moderate Laryngeal Dysplasia in the Context of Classification Systems and Clinical Decision Making. Laryngoscope. 2025;135(9):3296-3305. doi:10.1002/lary.32200
15. Pınarbasli MÖ, Gürbüz MK, Uzun T, et al. Risk for Progression to Invasive Carcinoma in Patients With Vocal Cord Dysplastic Lesions: Long-Term Follow-Up Results KBB-Forum 2020;19(1):069-073
16. Viana Pinto J, Ruas JJ, Rodrigues JA, et al. Prognostic Role of the Initial Grade of Dysplasia on Premalignant Vocal Fold Lesions. J Voice. 2025;39(1):238-244. doi:10.1016/j.jvoice.2022.07.015
17. Brunner E, Eberhard K, Gugatschka M. Prevalence of Benign Vocal Fold Lesions: Long-Term Results From a Single European Institution. J Voice. Published online November 24, 2023. doi:10.1016/j.jvoice.2023.11.006