| BackgroundClinical and pathological characteristics of patients with vocal cord leukoplakia were summarized.One is to analyze the correlation between the morphological characteristics of leukoplakia under electronic laryngoscope and pathological grade,explore the morphological classification and its ability to predict the pathological type;The other is to investigate the relationship between clinic pathological features and recurrence and malignancy.It may set a stage for the subsequent clinical diagnosis,treatment and follow-up of leukoplakia.The clinician can improve the accuracy of the clinical judgment of the risk degree of vocal cord leukoplakia before surgery.And simultaneously it may provide a theoretical basis for formulating a reasonable treatment plan and an effective follow-up strategy.MethodsThe study included 374 cases of vocal cord leukoplakia patients who were hospitalized and underwent surgical treatment at the Qilu Hospital of Shandong University from January 2012 to December 2019.Clinical data of them,including gender,age,smoking and alcohol history,symptoms and onset characteristics,endoscopy data,pathological type,treatment and follow-up,were analyzed retrospectively studied in order to comprehensively investigate the relationship between clinical manifestations,morphological characteristics,pathological characteristics,and influential factors of recurrence and malignancy.Result1.The relationship between the morphological characteristics of leukoplakia of the vocal cords and the pathological type:the size,edge,texture,surface condition and involvement of the anterior commissure were statistically different among different pathological types(P<0.001),suggesting that the pathological type is poorer,if it has greater range,elevated edge,heterogeneous texture,rough surface and involves the anterior commissure.2.The relationship between morphological classification of leukoplakia and pathological types:combining the analysis results of the correlation between morphological and pathological characteristics,and also referring to the method with observation consistency and reliability of classification to flat smooth,elevated smooth,and rough.In this study,the texture,edges,and surface conditions of the leukoplakia of the vocal cords are included in the classification basis and are divided into three types:type Ⅰ,which is flat and smooth type;typeⅡ,which is smooth uplift type;type Ⅲ,which is rough type.The postoperative histopathological results of type Ⅰ were mainly squamous epithelial hyperplasia(76.00%),which were 2.5 times and 76 times what the type Ⅱ and type Ⅲ is.And the pathology of CIS did not appear in type Ⅰ.Type Ⅱ is dominated by the pathological type of severe dysplasia,with 86 sides(43.70%,n＝197).There is a positive correlation between morphological classification and pathological type(P<0.001),suggesting that the higher the morphological classification is,the worse the pathological type is.3.The relationship between clinic pathological characteristics and risk grades:the age of the low-risk group is less than that of the high-risk group.Through single factor analysis,the differences between age,whether involving the anterior commissure,size of lesion range,morphological classification and two risk grades are statistically significant(P<0.01).The gender,disease course,smoking history,drinking history,hoarseness state had no relationship with risk grades(P>0.05).The multiple logistic regression showed that age(P=0.023,OR=1.933,95%CI=1.093-3.418)and morphology classification(P=0.048,OR=7.892,95%CI＝1.015-61.357;P<0.001,OR＝143.725,95%CI=18.967-1089.123)were the independent factors influencing the risk grades.4.The relationship between clinic pathological characteristics and recurrence and malignancy:follow-up of 355 patients,the overall recurrence rate was 10.7%,the overall malignancy rate was 5.9%,and the average malignancy interval was 1.83 years.In univariate analysis,the recurrence rates of patients with different sizes,morphological types,and pathological types were significantly different(P<0.05),which were incorporated into the multivariate COX regression analysis.It showed that histopathological type was an independent risk factor for leukoplakia recurrence.The more alcohol drinking is,the higher the morphological classification is,the worse the pathological types is,the higher the rate of malignancy would be(P<0.05).Additionally,the rate of malignancy is significant different between the non-dysplasia group and the severe dysplasia/CIS group.But the multi-factor COX regression analysis did not obtain its independent risk factors.It seems that the pathological type can be used as one of the predictors of recurrence and malignancy,but at the same time,other risk factors of the patients should be considered comprehensively,the other,severe dysplasia or above seems to be the most meaningful predictor of the risk of malignant transformation of leukoplakia.Conclusions1.The pathological grading can be predicted by the morphological characteristics of the larynx leukoplakia under the electronic laryngoscope,including:size,edge,texture,surface condition,and whether involving the anterior commissure.When the range is greater,the edge is elevated,the texture is heterogeneous,the surface is more rough or the anterior commissure is involved,the pathological results has the higher the degree of dysplasia.2.For patients with advanced age,larger range,higher morphological classification and the anterior commissure involving,we need to be alert to the possibility of being a high-risk type.3.According to the edge,texture,and surface conditions,the vocal cord leukoplakia are divided into three types,including:type Ⅰ flat and smooth type,type Ⅱuplift and smooth type,type Ⅲ rough type.Furthermore,it can be used to predict the pathological genres,recurrence and malignancy.4.The size of the lesion,morphological classification and the pathological genre have a certain influence on the recurrence,further,the pathological type is an independent risk factor for the recurrence of leukoplakia.The malignancy can be predicted by the drinking history,morphological classification and the pathological genre,and severe dysplasia/CIS may be the more significant prediction of malignancy. |
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