Laryngeal dysplasia, demographics, and treatment: a single-institution, 20-year review.

Abstract

Laryngeal dysplasia is a common disease entity that remains clinically frustrating because functional outcomes are balanced against oncologic results. Understanding evolution in dysplasia demographics, treatment, and progression rates may inform better therapy in the future. To review laryngeal dysplasia cases at a single institution during the last 20 years and identify changes in patient demographics, categorize treatment approaches, and review rates of progression to cancer. In this retrospective medical record review, patients with laryngeal dysplasia treated at an academic medical center were identified on review of pathology records. Patients were organized by date of dysplasia diagnosis, divided into 2 groups (group 1, January 1, 1993, through December 31, 2002; group 2, January 1, 2003, through December 31, 2012), and compared against one another. Age at diagnosis, sex, type of treatment, and progression to malignant disease were analyzed from one period to the next. A total of 107 patients were identified through review of pathology databases. Progression of dysplasia to cancer remained roughly stable across periods, at 8.8% and 8.0%, respectively. Mean age at diagnosis decreased from 68.7 to 61.7 years over time, with a statistically significant trend toward presentation at younger ages. The male to female ratio was 3.75 in group 1 and 3.17 in group 2, with a trend toward a greater proportion of females over time that did not reach statistical significance. Use of radiotherapy remained stable across groups, with increased use of microflap excision techniques and laser treatment (especially photoangiolytic lasers) in group 2. Overall, progression of laryngeal dysplasia to cancer has remained stable during the past 20 years at a rate of approximately 8%. Although laryngeal dysplasia remains a disease predominantly found in males, there is a demographic trend toward diagnosis at earlier ages. Treatment choices may slowly be changing over time, although multi-institutional studies may be required to better categorize this shift.