Histopathological variability and the prognosis of laryngeal premalignant lesions

Abstract

To investigate the histopathological subjective difference of laryngeal epitheliual premalignant lesions and to analyze the prognosis of every grade of laryngeal epitheliual premalignant lesion. According to 2005 WHO classification system, 237 cases of laryngeal epitheliual premalignant lesions were reviewd by 3 pathologists, meanwhile, the histopathological consistency among 3 pathologists was estimated with κ-statistics method. The Kaplan-Meier survival analysis were performed to assess the prognosis of every grade of laryngeal epitheliual premalignant lesion with follow-up data. There was totally a moderate consistency among 3 pathologists (κ values: 0.598 9), the histopathological difference was mainly between mild dysplasia and moderate dysplasia and between severe dysplasia and carcinoma in situ. The follow-up duration was between 18-120 months, and the median follow-up duration was 38 months. The carcinoma trsnformation rate was 8.44% (20/237) with an average malignant transformation duration of (19.45 ± 7.32) months, which was increased with the degree of dysplasia(mild dysplasia:1.67%, moderate dysplasia:3.57%, severe dysplasia:10.60%, carcinoma in situ:18.18%), no difference could be found between mild and moderate dysplasia, between moderate and severe dysplasia; Moreover, there was no difference between severe dysplasia and carcinoma in situ (P > 0.05). The histopathological variability brought the uncertainty for classification of laryngeal epitheliual premalignant lesions, which might have an impact on clinical management of laryngeal epitheliual premalignant lesions; there was obvious difference in carcinoma transformation between low-risk and high-risk laryngeal epitheliual premalignant lesions, and more attention on treatment and prognosis assessment should be paid for severe dysplasia as carcinoma in situ.