Dysplasia and Carcinoma in Recurrent Respiratory Papillomatosis Patients Older Than 45 Years.

Abstract

Variable evidence on risk factors for dysplasia and malignant transformation in RRP exists. Dysplasia has been reported in 10%-55% of adult recurrent respiratory papillomatosis (RRP) patients, but existing literature may misrepresent typical adult RRP age ranges. We aim to evaluate risk factors for the development of dysplasia and malignancy in RRP patients > 45 years old. We conducted a retrospective chart review of adult patients diagnosed with RRP > 45 years of age from 2008 to 2022. A two-tailed t-test was performed for continuous variables, and Chi-squared analysis and Fisher's exact test were used for categorical variables. There were 49 total patients with a mean age of 58.7 (45-80) years; 28 (57%) had some degree of dysplasia; 21 (43%) had no dysplasia. Of those with dysplasia, 9 (32%) had high-grade, and 19 (68%) had low-grade. Seven (14%) patients developed laryngeal squamous cell carcinoma; high-grade (5/7) was more likely than low-grade (2/7) dysplasia to progress to carcinoma (p = 0.012). A history of smoking and pack-years was associated with dysplasia (p = 0.044 and p = 0.018 respectively) but not malignancy. Laryngopharyngeal reflux, alcohol use, diabetes, or immunosuppression were not associated with dysplasia or malignancy. Of note, no patient who developed malignancy had received Gardasil vaccination (p = 0.08). Our study of RRP patients > 45 years old shows a higher incidence of dysplasia than current literature reports for adult patients > 18 years. Smoking history was correlated with dysplasia but not malignancy. All patients who developed malignancy demonstrated previous dysplasia, and malignant transformation was significantly associated with high-grade dysplasia.