Morphology And Pathology Of Vocal Cord Leukoplakia And Its Relationship With Recurrence And Malignant Transformation

Objective:We analyzed the effects of morphological and pathological changes in vocal cord leukoplakia on recurrence and malignant transformation of vocal cord leukoplakia.The morphological and pathological analysis of vocal cord leukoplakia was performed to predict the pathological properties of leucorrhea leukoplakia before treatment,and to explore its effects on recurrence and malignant transformation,in order to reduce the recurrence rate and malignant transformation rate after vocal leukoplakia treatment.Methods:From January 2013 to January 2018,220 cases of vocal cord leukoplakia patients admitted to the Second Hospital of Jilin University were analysed retrospectively,and the morphology(size,thickness,surface condition,single and double side,anterior joint condition)of the vocal cord leukoplakia under the electronic laryngoscope was interpreted and classified according to the morphological characteristics of the electronic laryngoscope.First,vocal cord leukoplakia was classified into two types based on the extent of lesion,either more or less than half theentire vocal cord.Secondly,according to the morphological characteristics of the vocal cord leukoplakia,it is divided into4 types.? :the vocal cord leukoplakia surface is smooth and flat,II :the vocal cord leukoplakia surface outward exogenous growth,including the II1 smooth ridge type and the II2 rough ridge,III :the surface of the vocal cord leukoplakia is ulcerative.The postoperative pathology was divided into simple hyperplasia,mild hyperplasia,moderate hyperplasia,severe hyperplasia and carcinoma,and further divided into high risk group and low group.The patients were followed up regularly after discharge,and the follow-up results were recorded as no recurrence,recurrence,and malignant transformation.The ?2testorthe Fisher exactprobabilitymethod,t-test,Ranksumtest,Spearman nonparametric correlation test and Logistic regression model were used to investigate the indexes.Two-sided Pvalues<0.05 wereconsideredstatistically significant.All calculations were performed with SPSS software(version 23.0).Results:1.The study group of 220 patients,One side(left or right side): 136 cases(44.9%),and bilateral cases(84.5%),total lesions of the vocal cords 304 side.2.The vocal cord leukoplakia involving less than half of the vocal cord was observed in 161(52.1%)vocal cords,The vocal cord leukoplakia with extension beyond half ofthe vocal cord was seen in 143 vocal cords(52.1%).3.According to morphological features,?(superficial type):61 sides(20.0%),followed by exophytic type(?1,?2),and ulcerative type(?).II1 smooth ridge type 99 side(33.1%),II2 rough ridge type 127 side(41.6%),type III(vocal leukoplakia surface ulcerated)16 side(5.2%).4.171 had simple hyperplasia with or without leukokeratosis(56.7 %),48 had mild dysplasia(15%),38 had moderate dysplasia(12.5 %),47 had severe dysplasia and carcinoma(15.4 %).Among them,257 sides(84.0%)in the low-risk group and 47 sides(15.4%)in the high-risk group.5.145 patients were treated surgical vocal cords leukoplakia resection by CO 2 lasers using the microlaryngeal instruments,including 20 patients(13.8%)with recurrence,and 5 patients with malignant transformation(3.4%).Of the vocal cords with simple hyperplasia,8(7.7%)had recurrence and no malignant transformation;Of the vocal cords with mild dysplasia,4(14.8%)had recurrence and 2(7.4%)had malignant transformation;3(10.0%)had recurrence and 3(10.0%)had malignant transformation in the vocal cords with moderate dysplasia;7(29.2%)had recurrence in the vocal cords with severe dysplasia and 1(4.2%)had malignant transformation.Conclusion:1.The vocal cord leukoplakia involving less than half ofthe vocal cord as many as involving beyond half of the vocal cord.The main morphological types were type?1 and ?2,followed by type.More than half of the pathological changes of vocal cord leukoplakia are simple hyperplasia,while the other mild,moderate and severe atypical hyperplasia account for the same proportion.2.By x2 test,the pathological range,morphological type and pathological diagnosis of vocal cord leukoplakia under electronic laryngoscope were different,and the difference was statistically significant(P=0.000,P<0.05).The larger the pathological range of vocal cord leukoplakia and the higher the grade of morphological type,the worse the pathological results were.3.The recurrence rate of vocal cord leukoplakia was about 13.8% and the canceration rate was about 3.4%.Multivariate analysis showed that size(OR= 6.364,P=0.015<0.05),morphology(OR=8.144,P=0.000<0.05)and pathology(OR= 1.576,P=0.017<0.05)of vocal cord leukoplakia are independent risk factors for the prognosis(recurrence)of vocal cord leukoplakia,which indicates that the larger the pathological range of vocal cord leukoplakia,the higher the morphological grade,the higher the risk of recurrence;the worse the pathological results of vocal cord leukoplakia,the higher the risk of recurrence.Pathology(OR= 2.031,P=0.046<0.05)and morphology(OR= 4.929,P=0.023<0.05)of vocal cord leukoplakia are independent risk factors for the prognosis(canceration)of vocal cord leukoplakia,which indicates that the higher the morphological grade of vocal cord leukoplakia,the greater the risk of canceration after operation;the worse the pathological results,the more prone to canceration after operation.The size of vocal cord leukoplakia(OR = 2.807,P = 0.351 > 0.05)had no significant difference with the canceration of vocal cord leukoplakia,that is,the lesion range of vocal cord leukoplakia had no correlation with the occurrence of canceration after operation.