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Botini DS, Rodrigues SA, Castilho GL, Mercuri G, Martins RHG. Vocal Folds Leukoplakia: The Efficacy of Vitamin A in the Initial Treatment. Int Arch Otorhinolaryngol 2022; 27:e97-e103. [PMID: 36714893 PMCID: PMC9879634 DOI: 10.1055/s-0042-1742767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/14/2021] [Indexed: 11/12/2022] Open
Abstract
Introduction Laryngeal leukoplakia corresponds to a white lesion in the mucosa developed by the deposit of keratin in the epithelium, potentiated by chronic smoking. It is considered a preneoplastic lesion. Surgery is the most adopted treatment; however, non-surgical treatment is advocated by some authors. Objective To evaluate the effectiveness of vitamin A in the management of vocal fold leukoplakia. Methods Patients with videolaryngoscopy diagnosis of vocal fold leukoplakia were selected. The endoscopic images were photographed and with the aid of the ImageJ software (National Institutes of Health, Bethesda, MD, USA), the proportion of the size of the leukoplakia was calculated. Eligible patients were prescribed 50,000U of vitamin A, twice daily for 2 months, at which point videolaryngostroboscopy was repeated for comparative analysis between pre and posttreatment. The efficacy of the treatment was classified as: outcome I - complete improvement of the lesion, outcome II - partial improvement, and outcome III - no difference or increased lesion size. Results Fifteen patients (eight women, seven men) were included, six of whom had bilateral lesions. Smoking was reported in 86.8% of patients. Complete improvement of the lesion was found in 7 cases (33.4%, outcome I), partial improvement in 6 (28.6%, outcome II), and worsening of the injury in 8 (38.1%, outcome III). Of the latter, 6 underwent microsurgery; histopathology indicated absence of dysplasia in 3, and mild dysplasia in 3. Conclusions In this study, the treatment with vitamin A at a dose of 100,000 IU daily for 2 months was effective in reducing the laryngeal leukoplakia size in 62% of cases.
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Affiliation(s)
- Dayane Silvestre Botini
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | | | - Gustavo Leão Castilho
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | - Gustavo Mercuri
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil
| | - Regina Helena Garcia Martins
- Ophthalmology, Otorhinolaryngology, Head and Neck Surgery Department, Universidade Estadual Paulista(Unesp), Botucatu, SP, Brazil,Address for correspondence Regina H. G. Martins, MD, PhD Ophthalmology, Otorhinolaryngology and Head Neck Surgery Department, Botucatu Medical School – Universidade Estadual Paulista Júlio de Mesquita FilhoDistrito de Rubião Junior s/n, 18618-970; Botucatu, SPBrazil
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Videolaryngoendoscopic and Stroboscopic Evaluation in Predicting the Malignancy Risk of Vocal Fold Leukoplakia. J Clin Med 2022; 11:jcm11195789. [PMID: 36233657 PMCID: PMC9571578 DOI: 10.3390/jcm11195789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Vocal fold leukoplakia (VFL), despite our knowledge of its etiopathogenetic factors, and the development of laryngeal visualization, remains a diagnostic and therapeutic challenge. Objective: This research aimed to explore the efficacy of clinical and morphological feature identification in videolaryngoendoscopy (VLE) using a three-tier classification, and videolaryngostroboscopy (VLS) in predicting the risk of VFL malignant transformation. Material and Methods: We examined 98 patients with VFL by flexible endoscopy under VLE and VLS. Morphological characteristics of 123 lesions including the surface, margin, and texture were assessed; then, VFL was subdivided into three types: I—flat and smooth, II—elevated and smooth, and III—rough. Based on the histopathological findings, 76 (61.79%) lesions were classified as low- and 47 (38.21%) lesions as high-grade dysplasia. Results: The inter-rater agreement between two raters evaluating the VFL in VLE was almost perfect (Cohen’s kappa = 0.826; p < 0.00; 95%CI 0.748−0.904). In ROC curve analysis, the AUC difference between Rater I and Rater II was 0.024 (0.726 vs. 0.702). In multivariate analysis, high-risk VFL was positively related to unilateral plaque localization (p = 0.003), the type III VLE classification (p = 0.013), absence of a mucosal wave (p = 0.034), and a positive history of alcohol consumption (p = 0.047). In ROC analysis, VLE had an AUC of 0.726, with a high sensitivity of 95.7% and low specificity of 40.8%. The NPV was high, at 93.9%; however, the PPV was low, at 50%. The proposed logistic regression model including features significant in multivariate analysis showed lower sensitivity (80.9% vs. 95.7%) and lower NPV (86.2% vs. 93.9%); however, the specificity and PPV were improved (73.7% vs. 40.8% and 65.5% vs. 50.0%, respectively). Conclusions: The combination of clinical history with endoscopic (plaque morphology) and stroboscopic examination (mucosal wave assessment) can fairly estimate the degree of dysplasia in VFL and thus is recommended for use in clinical settings. The findings of this study can be used to guide the decision regarding immediate biopsy or watchful waiting.
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Xiao S, Li J, Zheng H, Li X, Yang H, Zhang J, Peng X, Zhou S, Zhao C, Chen D, Xiao X, Shi L, Huangfu H, Tao Z, Chen X, Liu Y, Qu S, Wang G, Chen T, Cui X, Tian L, Zhou W, Fang H, Huang Y, Yu G, Lin Z, Tang L, He J, Ma R, Yu Z. Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey. BMJ Open 2022; 12:e058852. [PMID: 35732392 PMCID: PMC9226935 DOI: 10.1136/bmjopen-2021-058852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists. DESIGN Multi-centre cross-sectional survey. SETTING 220 medical centres in different regions of China. PARTICIPANTS A total of 2254 otolaryngologists from 220 medical centres in China who were successfully on-site surveyed between November 2019 and December 2020. MAIN OUTCOME MEASURES Awareness about LPRD included knowledge about risk factors, symptoms, laryngoscope signs, related diseases, current diagnostic methods and treatments. RESULTS The percentage of participants who had heard of LPRD was 96.4%, with academic conferences as the most common source of information (73.3%). The most commonly known risk factor, symptom, laryngoscope sign, related disease, diagnostic method and treatment were alcohol consumption (44.0%), pharyngeal foreign body sensation (66.9%), hyperaemia (52.4%), pharyngolaryngitis (54.8%), pH monitoring (47.6%) and medication (82.1%), respectively. Only 28.3% of all participants knew that 24 h pH or multichannel intraluminal impedance pH monitoring was the most accurate diagnostic test. As many as 73.1% of all participants knew that proton pump inhibitors were the first-line treatment drugs. An analysis of the overall status of awareness using a scoring system suggested that otolaryngologists were better aware owing to more access, working at 3A hospitals, and postgraduate or above educational background (all p<0.05). CONCLUSION Although the majority of Chinese otolaryngologists had heard of LPRD, their overall awareness about the disease was not encouraging. More efforts are needed to increase the knowledge about LPRD among this group of physicians. TRIAL REGISTRATION NUMBER ChiCTR1900025581.
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Affiliation(s)
- Shuifang Xiao
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Jinrang Li
- Department of Otolaryngology, Head and Neck Surgery, The Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongliang Zheng
- Department of Otolaryngology, Head and Neck Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Xiangping Li
- Department of Otolaryngology, Head and Neck Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hui Yang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Junbo Zhang
- Department of Otolaryngology, Head and Neck Surgery, Peking University First Hospital, Beijing, China
| | - Xiaoxia Peng
- Clinical Epidemiology and Evidence-based Medicine Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Shuihong Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Chen Zhao
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Donghui Chen
- Department of Otolaryngology, Head and Neck Surgery, Jiangsu Province Hospital, Nanjing, Jiangsu, China
| | - Xuping Xiao
- Department of Otolaryngology, Head and Neck Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, Hunan, China
| | - Li Shi
- Department of Otolaryngology, Head and Neck Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, Shaanxi, China
| | - Hui Huangfu
- Department of Otolaryngology, Head and Neck Surgery, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhenfeng Tao
- Department of Otolaryngology, Head and Neck Surgery, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Xiong Chen
- Department of Otolaryngology, Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yehai Liu
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Shenhong Qu
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Guangke Wang
- Department of Otolaryngology, Head and Neck Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Ting Chen
- Department of Otolaryngology, Head and Neck Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Xiaobo Cui
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China
| | - Linli Tian
- Department of Otolaryngology, Head and Neck Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Wensheng Zhou
- Department of Otolaryngology, Head and Neck Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hongyan Fang
- Department of Otolaryngology, Head and Neck Surgery, Chongqing General Hospital, Chongqing, China
| | - Yongwang Huang
- Department of Otolaryngology, Head and Neck Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guodong Yu
- Department of Otolaryngology, Head and Neck Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Zhenqun Lin
- Department of Otolaryngology, Head and Neck Surgery, Hainan Provincial People's Hospital, Haikou, Hainan, China
| | - Liang Tang
- Department of Otolaryngology, Head and Neck Surgery, The People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Jian He
- Department of Otolaryngology, Head and Neck Surgery, Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Ruixia Ma
- Department of Otolaryngology, Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Zhaoyan Yu
- Department of Otolaryngology, Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong Provincial ENT Hospital Affiliated to Shandong University, Jinan, Shandong, China
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Campello C, Lima-Silva M, de Lima E, Nunes G, Silva H, Dellalibera E, de Britto L, Lemos C, Muniz M. Genetic polymorphisms and protein levels in vocal fold leukoplakia: a systematic review. Braz J Med Biol Res 2022; 55:e11920. [PMID: 35293553 PMCID: PMC8922550 DOI: 10.1590/1414-431x2022e11920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/13/2022] [Indexed: 12/03/2022] Open
Abstract
Vocal fold leukoplakia (VFL) has a risk of malignant transformation. Therefore, patients can have symptoms such as dysphonia, vocal strain, difficulty breathing, and dysphagia. Additionally, there is a genetic predisposition that can be associated with genetic polymorphisms. We aimed to evaluate the influence of genetic polymorphisms and protein levels in the etiology of VFL. Our study followed the PRISMA checklist and was registered on PROSPERO database. The questions were: "Are genetic polymorphisms involved in the etiology of VFL? Are protein levels altered in patients with VFL?". Eligibility criteria were case control studies that compared the presence of polymorphisms or/and protein levels of subjects diagnosed with VFL and healthy controls. Of the 905 articles retrieved, five articles with a total of 1038 participants were included in this study. The C allele of the single nucleotide polymorphisms (SNP)-819 T/C IL-10, A allele of the SNP -592 A/C IL-10, CT genotype of the SNP rs11886868 C/T BCL11A, GG genotype of the SNP rs4671393 A/G BCL11A, LL genotype, and L allele of (GT)n repeat polymorphisms of the HO-1 were risk factors for VFL development. Nevertheless, there was a lack of association between VFL and the -1082 A/G IL-10, rs14024 CK-1, and -309 T/G Mdm2 SNPs. The concentrations of the MDM2, BCL11A, and HO-1 proteins were modified, while IL-10 levels were normally expressed in these subjects. In conclusion, most markers evaluated in this review could be potential indicators to develop effective therapies, avoiding a malignant transformation of the lesion.
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Affiliation(s)
- C.P. Campello
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | - M.F.B. Lima-Silva
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - E.L.S. de Lima
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Programa de Pós-Graduação em Ciências da Saúde, Faculdade de
Ciências Médicas, Universidade de Pernambuco, Recife, PE, Brasil
| | - G.R.S. Nunes
- Programa Associado de Pós-Graduação em Fonoaudiologia,
Universidade Federal da Paraíba, João Pessoa, PB, Brasil
| | - H.A.M. Silva
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
| | - E. Dellalibera
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
| | | | - C.A.A. Lemos
- Departamento de Odontologia, Universidade Federal de Juiz de
Fora, Governador Valadares, MG, Brasil
| | - M.T.C. Muniz
- Laboratório de Biologia Molecular, Centro de Oncohematologia
Pediátrica, Hospital Universitário Oswaldo Cruz, Universidade de Pernambuco,
Recife, PE, Brasil
- Instituto de Ciências Biológicas, Universidade de Pernambuco,
Recife, PE, Brasil
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Han P, Li Y, Liang F, Ye Y, Wang J, Li X, Ouyang N, Huang X. Polymorphisms of acetaldehyde dehydrogenase 2 and alcohol dehydrogenase 1B on the malignant transformation of vocal cord leukoplakia: A Chinese cohort. Mol Carcinog 2022; 61:472-480. [PMID: 35040215 DOI: 10.1002/mc.23391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/28/2021] [Accepted: 01/01/2022] [Indexed: 11/05/2022]
Abstract
Severe dysplasia of vocal cord leukoplakia (VCL) is more likely to occur in laryngeal carcinoma. Alcohol dehydrogenase and acetaldehyde dehydrogenase are both important enzymes in alcohol metabolism. This study aimed to investigate the incidence rate of malignant transformation in patients with VCL and the role of drinking habits and ALDH2 and ADH1B genetic polymorphisms in the malignant transformation of VCL. From January 2007 to January 2017, 136 cases of VCL were included in this retrospective analysis. Information on medical history, alcohol and tobacco consumption habits, ALDH2 and ADH1B genotypes, gastroesophageal reflux, and clinical pathological characteristics of VCL was collected. As a result, patients had a median follow-up of 9.6 years (interquartile range: 7.5-12.5 years). Twenty-three of 136 VCL patients finally developed laryngeal carcinoma, resulting in a cumulative malignant transformation rate of 16.9%. Cox regression analysis demonstrated that the independent risk factors for the malignant transformation of VCL included age over 60 years (hazard ratio [HR]: 13.872, p < 0.001), ALDH2 *2 allele status (HR: 9.694, p < 0.001), alcohol (HR: 10.011, p < 0.001) and tobacco (HR: 8.869, p < 0.001) exposure after operation, and drinking frequency (HR: 2.178, p = 0.016). Therefore, among patients over 60 years old, an ALDH2-inactivating mutation and excessive ethanol and tobacco consumption are potential contributors to the malignant transformation of VCL.
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Affiliation(s)
- Ping Han
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yixin Li
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Otolaryngology, Guangdong Women and Children Hospital, Guangzhou, China
| | - Faya Liang
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuchu Ye
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jingyi Wang
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaojuan Li
- Department of Pathology, Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nengtai Ouyang
- Department of Pathology, Cellular and Molecular Diagnostics Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaoming Huang
- Department of Otolaryngology, Head and Neck Surgery, and Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Park JC, Altman KW, Prasad VMN, Broadhurst M, Akst LM. Laryngeal Leukoplakia: State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:1153-1159. [DOI: 10.1177/0194599820965910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to consider when managing such patients. Data Sources PubMed/MEDLINE. Review Methods We conducted a detailed review of publications related to vocal cord and laryngeal leukoplakia, dysplasia, hyperkeratosis, leukoplakia endoscopy, and leukoplakia management focusing specifically on oncologic outcomes, voice preservation, current and emerging diagnosis, and management techniques. Conclusions There has been a paradigm shift away from performing “vocal cord stripping” procedures that can cause irreversible hoarseness toward voice preservation surgery while achieving comparable oncologic control. Surgical technical and instrumental developments have been designed to maximally treat superficial disease while preserving underling vibratory mucosa. Recent improvements in histopathological grading systems and advances in biomarker classification may allow for improved oncologic risk stratification. Furthermore, improvements in endoscopic imaging capabilities and contact endoscopy are currently being studied for their potential diagnostic significance. Implications for Practice To optimally manage vocal fold leukoplakia, the otolaryngologist should become familiar with the oncologic implications of the disease and the importance of obtaining pathologic diagnosis to rule out malignancy. In addition, the surgeon should maintain surgical techniques and knowledge of available instruments and lasers that can assist in surgical management while prioritizing the preservation of vibratory tissue and voice quality. Finally, the surgeon and the patient should understand the clinical importance of routine endoscopic surveillance.
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Affiliation(s)
- Joseph C. Park
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kenneth W. Altman
- Department of Otolaryngology–Head and Neck Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | | | | | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Wan P, Ongkasuwan J, Martinez J, Sandulache V, Deng D, Jiang J, Sikora A, Altman KW. Biomarkers for Malignant Potential in Vocal Fold Leukoplakia: A State of the Art Review. Otolaryngol Head Neck Surg 2020; 164:751-758. [PMID: 32988279 DOI: 10.1177/0194599820957251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To explore biomarkers that are candidates for understanding potential degeneration to malignancy of vocal fold leukoplakia (VFL), with the goal of guiding future diagnostic and treatment recommendations. DATA SOURCES PubMed and Medline search engines. REVIEW METHODS A systematic review was conducted by searching the following key words: vocal fold or laryngeal, coupled with leukoplakia or dysplasia, and combined with the term prognostic markers. We collated the biomarkers and their significance, followed by observing the power of their evidence by assessing the quality of the studies according to guidelines of tumor marker prognostic studies (REMARK). CONCLUSIONS Prognostic biomarkers in the 16 studies are generally divided into 3 categories according to their biological roles: proliferation (Ki-67, CK-1 RS14024 SNP), cell cycle control (P53, p16, cyclin D1, p57kip2, interleukin-10 [IL-10], miR-10a, and miR-34c), cell adhesion, and invasion (neutrophil-to-lymphocyte ratio, OPN/CD44v6 axis, MMP-1, vascular endothelial growth factor A, MMP-9, serpin peptidase inhibitor 1, plasminogen activator, CTNN/B1, β-catenin, NANOG, HERG1). The prognostic use of these biomarkers is limited due to the variable methodologies, study design, assay methods, and statistical analysis performed. IMPLICATIONS FOR PRACTICE Prognostic factors in vocal fold leukoplakia have important clinical implications regarding the potential for malignant degeneration. Although further study is needed, the currently available evidence suggests that p53, p16, cyclin D1, IL-10, NLR, OPN and CD44v6, CTNNB1, and CTTN and FAK might be of particular interest in determining prognosis of VFL as related to malignancy. Future, large, well-designed, prospective studies are expected to determine the prognostic power of these biomarkers before their implementation in routine clinical practice.
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Affiliation(s)
- Ping Wan
- School of Rehabilitation Sciences, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Julina Ongkasuwan
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Julian Martinez
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Vlad Sandulache
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Defeng Deng
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Jack Jiang
- Department of Otolaryngology, University of Wisconsin, Madison, Wisconsin, USA
| | - Andrew Sikora
- Department of Otolaryngology, Baylor College of Medicine, Houston, Texas, USA
| | - Kenneth W Altman
- Department of Otolaryngology, Geisinger Health System, Danville, Pennsylvania, USA
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8
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Chen YL, Bao YY, Zhou SH, Yao HT, Chen Z. Relationship Between Pepsin Expression and Dysplasia Grade in Patients With Vocal Cord Leukoplakia. Otolaryngol Head Neck Surg 2020; 164:160-165. [PMID: 32692278 DOI: 10.1177/0194599820938654] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To measure pepsin expression in patients with vocal fold leukoplakia and elucidate its clinical significance. STUDY DESIGN Retrospective analysis of pathologic archive specimens. SETTING Affiliated university hospital. SUBJECTS AND METHODS The study included 45 patients with vocal fold leukoplakia and 19 with vocal fold polyps who underwent surgical treatment between December 2013 and July 2016. Masses were detected on both vocal cords in 5 patients with vocal fold leukoplakia and in 1 patient with vocal fold polyps. Immunohistochemistry was used to assess pepsin expression. In addition, the relationship of pepsin expression level with clinical characteristics of vocal fold leukoplakia was assessed. RESULTS The rate of pepsin expression was high in the polyp group (75%) and the leukoplakia group (68%); however, the difference between groups was not significant (P > .05). Pepsin expression significantly increased according to grade of dysplasia (mild, 57.1%; moderate, 88.9%; severe, 100.0%; P = .034). Similarly, the percentage of lesions that exhibited strongly positive pepsin expression increased with the grade of dysplasia (mild, 37.1%; moderate, 66.7%; severe, 100.0%; P = .005). The leukoplakia recurrence rate was higher in patients with positive pepsin expression than in patients with negative pepsin expression but without a significant difference (P > .05). CONCLUSION Our study suggests that pepsin was associated with the grade of dysplasia of vocal cord leukoplakia. Further investigation with appropriate control groups and controlling for other risk factors, such as smoking or alcohol consumption, is needed.
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Affiliation(s)
- Ya-Lian Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Otolaryngology, The People's Hospital of Shengzhou City, Shengzhou, China
| | - Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Hong-Tian Yao
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zhe Chen
- Department of Otolaryngology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Lechien JR, Akst LM, Saussez S, Crevier-Buchman L, Hans S, Barillari MR, Calvo-Henriquez C, Bock JM, Carroll TL. Involvement of Laryngopharyngeal Reflux in Select Nonfunctional Laryngeal Diseases: A Systematic Review. Otolaryngol Head Neck Surg 2020; 164:37-48. [DOI: 10.1177/0194599820933209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objectives To investigate the existing published evidence supporting the role of laryngopharyngeal reflux (LPR) in the development of the select nonfunctional laryngeal diseases of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections Data Sources PubMed, Cochrane Library, and Scopus. Review Methods A systematic review was performed by 3 independent investigators for studies providing information about the prevalence and role of LPR in the development of laryngotracheal stenosis, granuloma, leukoplakia, and laryngeal infections. Diagnostic criteria and clinical outcome evaluation of included studies were analyzed with PRISMA criteria. Results Of the 64 relevant publications, 27 clinical and 4 basic science studies were included. Ten studies used objective reliable examinations for LPR diagnosis (eg, dual- or triple-probe or oropharyngeal pH monitoring, multichannel intraluminal impedance–pH monitoring, or pepsin detection). According to the bias analysis and the results of studies, the association between LPR and laryngotracheal stenosis, leukoplakia, laryngeal papillomatosis, or vocal fold granuloma remains poorly demonstrated. There is a notable heterogeneity among included studies regarding their inclusion criteria, diagnostic methods, and clinical outcome evaluation. Although some experimental findings support the involvement of bile salts and other gastroduodenal proteins active in alkaline pH, no included clinical studies assessed the role of nonacid and mixed reflux through multichannel intraluminal impedance–pH monitoring. Conclusion The involvement of LPR in the development of leukoplakia, laryngotracheal stenosis, vocal fold granuloma, and laryngeal papillomatosis is currently not demonstrated. The potential relationship between LPR and these select nonfunctional laryngeal diseases must be confirmed through future clinical and experimental studies considering acid, nonacid, and mixed LPR.
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Affiliation(s)
- Jerome R. Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lee M. Akst
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Laboratory of Anatomy and Cell Biology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium
- Department of Otorhinolaryngology and Head and Neck Surgery, CHU de Bruxelles, CHU Saint-Pierre, School of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Maria Rosaria Barillari
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Christian Calvo-Henriquez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France
- Department of Otorhinolaryngology and Head and Neck Surgery, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
| | - Jonathan M. Bock
- Division of Laryngology and the Professional Voice Department of Otolaryngology and Communication Science, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Thomas L. Carroll
- Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Division of Otolaryngology, Department of Surgery, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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Lechien JR, Allen J, Mouawad F, Ayad T, Barillari MR, Huet K, Crevier-Buchman L, Hans S, Karkos PD, Eun YG, Bobin F, Saussez S, Akst LM. Do Laryngologists and General Otolaryngologists Manage Laryngopharyngeal Reflux Differently? Laryngoscope 2020; 130:E539-E547. [PMID: 31913520 DOI: 10.1002/lary.28484] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/20/2019] [Accepted: 12/06/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate current practices of laryngologists and non-laryngologists in management of Laryngopharyngeal Reflux (LPR). METHODS An online survey was sent to members of otolaryngology societies about LPR, and subgroup analysis was performed between laryngologists and non-laryngologists. This survey was conducted by the LPR Study Group of Young Otolaryngologists of the International Federation of Otolaryngological Societies. RESULTS A total of 535 otolaryngologists completed the survey. Among them, 127 were laryngologists and 408 were non-laryngologists. Collectively, symptoms most commonly attributed to LPR are cough after lying down/meal, throat clearing, and acid brash; most common findings are thought to be arytenoid erythema and posterior commissure hypertrophy. Respectively, 12.5% and 5% of non-laryngologists and laryngologists believe that ≥50% of LPR patients suffer from heartburn (P = .010). Non-laryngologists are more aware about some extra-laryngeal findings associated with LPR (eg, pharyngeal erythema) than laryngologists. Neither laryngologists nor non-laryngologists associated development of benign lesions of the vocal folds with reflux. The management of LPR substantially differs between groups, with laryngologists indicating increased awareness of (impedance)-pH monitoring as well as the prevalence and treatment of nonacid/mixed LPR. Conversely, non-laryngologists are much more likely to include gastroenterology referral in their management of presumed LPR. Respectively, 44.8% and 27.6% of non-laryngologists and laryngologists believe themselves not sufficiently knowledgeable about LPR. CONCLUSIONS Significant differences exist between laryngologists and non-laryngologists in diagnosis and treatment of LPR. Overall only one-third of responders believe themselves to be sufficiently educated about LPR. LEVEL OF EVIDENCE 4 Laryngoscope, 130:E539-E547, 2020.
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Affiliation(s)
- Jerome R Lechien
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Jacqueline Allen
- Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand
| | - Francois Mouawad
- Department of Otorhinolaryngology and Head and Neck Surgery, CHRU de Lille, Lille, France
| | - Tareck Ayad
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - Maria Rosaria Barillari
- Division of Phoniatrics and Audiology, Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy
| | - Kathy Huet
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Laboratory of Phonetics, Faculty of Psychology, Research Institute for Language Sciences and Technology, University of Mons, Mons, Belgium
| | - Lise Crevier-Buchman
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Stéphane Hans
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Foch Hospital, Paris, France
| | - Petros D Karkos
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Thessaloniki Medical School, Thessaloniki, Greece
| | - Young-Gyu Eun
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Otorhinolaryngology and Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Francois Bobin
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Polyclinique Elsan de Poitiers, Poitiers, France
| | - Sven Saussez
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Anatomy and Experimental Oncology, Mons School of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons, Mons, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, CHU Saint-Pierre, Faculty of Medicine, University Libre de Bruxelles, Brussels, Belgium
| | - Lee M Akst
- Laryngopharyngeal Reflux Study Group of Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies, Paris, France.,Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
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