Предраковые поражения гортани: от скрининга к лечебному вмешательству.
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.48Ключевые слова:
гортань, предраковые поражения, дисплазия, скрининг, ВПЧАннотация
Предраковые поражения гортани, включая лейкоплакию, эритроплакию, эпителиальную дисплазию и рецидивирующий папилломатоз, имеют различный риск прогрессии в плоскоклеточный рак и представляют собой критическую точку в профилактике рака гортани. Цель данной статьи – обобщить современные данные об этиопатогенезе, скрининге, ранней диагностике и вариантах лечения. Методология основывалась на нарративном обзоре современной литературы и международных клинических рекомендаций. Результаты показывают, что риск малигнизации зависит от степени дисплазии (3–10% при лёгких формах и до 35–40% при тяжёлой дисплазии). Современные эндоскопические технологии, такие как узкополосная визуализация (NBI) и автофлуоресценция, повышают точность диагностики, в то время как эндоскопическая эксцизия с использованием СО₂- или KTP-лазера остаётся терапевтическим стандартом. Новые методы лечения — фотодинамическая терапия, противовирусные препараты, антиангиогенные средства и вакцинация против ВПЧ — демонстрируют перспективные результаты в снижении частоты рецидивов. Таким образом, ведение предраковых поражений гортани должно быть многопрофильным и персонализированным, а интеграция молекулярных биомаркеров и современных технологий открывает новые перспективы, оказывая значительное влияние на прогноз пациентов.
Библиографические ссылки
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide. CA Cancer J Clin. 2021;71(3):209-49.
Bray F, Laversanne M, Weiderpass E, Soerjomataram The ever-increasing importance of cancer as a leading cause of premature death worldwide. Cancer. 2021;127(16):3029-30.
Ferlay J, Ervik M, Lam F, et al. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer; 2020.
Marur S, Forastiere AA. Head and Neck Squamous Cell Carcinoma: Update on Epidemiology, Diagnosis, and Treatment. Mayo Clin Proc. 2016;91(3):386-96.
Shield KD, Ferlay J, Jemal A, Sankaranarayanan R, Chaturvedi AK, Bray F, Soerjomataram I. The global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2012. CA Cancer J Clin. 2017;67(1):51- 64.
Vanderpoorten V, Tomassen P, Huvenne W, et al. Quality of life after treatment of laryngeal cancer: systematic review. Head Neck. 2020;42(5):1063-75.
Yabroff KR, Lund J, Kepka D, Mariotto A. Economic burden of cancer in the United States: estimates, projections, and future research. Cancer Epidemiol Biomarkers Prev. 2011;20(10):2006-14.
Rettig EM, D’Souza G. Epidemiology of head and neck cancer. Surg Oncol Clin N Am. 2015;24(3):379-96.
Gale N, Poljak M, Zidar N. Update from the 4th Edition of the WHO Classification of Head and Neck Tumours: What is new in the 2017 WHO Blue Book for Tumours of the Larynx and Hypopharynx. Head Neck Pathol. 2017;11(1):23-32.
Vetricean S., Osman V., Cabac V., Sencu E., Chirtoacă B., Chirtoca D., Cernev D. Stările precanceroase ale laringelui: protocol clinic naţional PCN-192
Mehanna H, Paleri V, Robson A, Wight R. Consensus statement by the UK Head and Neck (UKHAN) group on management of dysplasia of the larynx. Clin Otolaryngol. 2010;35(2):170-5.
Cernev D., Cabac V. Recurrent Papillomatosis of the Larynx. Etiological Aspects, Risk Factors and the Prognosis of Clinical Evolution: A Review of Literature. Merit Research Journal of Medicine and Medical Sciences (ISSN: 2354-323X) Vol. 8(10) pp. 584-588, October, 2020
Cernev D, Cabac V. Noțiuni generale de epidemiologie, etiopatogenie și tratament în papilomatoza laringiană recidivantă. Bull Acad Sci Mold. Med Sci. 2021;(3):93-97.
Piazza C, Cocco D, Del Bon F, Mangili S, Nicolai P, Peretti G. Narrow band imaging in endoscopic evaluation of laryngeal cancer: a prospective study. Laryngoscope. 2010;120(2):215-9.
Kraft M, Fostiropoulos K, Gürtler N, Arnoux A, Arens C. Value of autofluorescence endoscopy for the detection of precancerous and cancerous lesions of the larynx. Head Neck. 2016;38(1):111-6.
F van der Sommen F, Zinger S, Curvers WL, et al. Computer-aided detection of early neoplastic lesions in the esophagus. Gastrointest Endosc. 2013;77(5):805-13.
Hecht SS. Tobacco smoke carcinogens and lung cancer. J Natl Cancer Inst. 1999;91(14):1194-210.
Boffetta P, Hashibe M. Alcohol and cancer. Lancet Oncol. 2006;7(2):149-56.
Pelucchi C, Gallus S, Garavello W, Bosetti C, La Vecchia C. Alcohol and tobacco use, and cancer risk for upper aerodigestive tract and liver. Eur J Cancer Prev. 2008;17(4):340-4.
Koufman JA, Aviv JE, Casiano RR, Shaw GY. Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders. Otolaryngol Head Neck Surg. 2002;127(1):32-5.
Mannetje A, Kogevinas M, Luce D, et al. Occupation and risk of laryngeal cancer in European men. Am J Epidemiol. 2003;157(6):470-8.
Syrjänen K. HPV infections and tonsillar carcinoma. J Clin Pathol. 2004;57(5):449-55.
Ndiaye C, Mena M, Alemany L, et al. HPV DNA, E6/E7 mRNA, and p16INK4a detection in head and neck cancers: a systematic review. Lancet Oncol. 2014;15(12):1319-31.
Ivancic R, Iqbal H, deSilva B, Pan Q, Matrka L. Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol. 2018;3(1):22-34.
Ferlito A, Shaha AR, Silver CE, et al. Premalignant lesions of the larynx: diagnosis and management. Head Neck. 2009;31(4):401-8.
Hellquist H, Cardesa A, Gale N, et al. Criteria for grading laryngeal dysplasia. Histopathology. 2014;65(4):454-64.
Black C, Maran AGD. Carcinoma in situ of the larynx. J Laryngol Otol. 1988;102(6):485-9.
El-Naggar AK, Chan JKC, Grandis JR, Takata T, Slootweg PJ, editors. WHO Classification of Head and Neck Tumours. 5th Edition. Lyon: IARC Press; 2022.
Thompson LDR, Franchi A. Update on selected head and neck tumors in the 5th edition of the WHO classification. Head Neck Pathol. 2022;16(1):1-16.
Cabac V. Papilomatoza recidivantă a laringelui la copil: aspecte epidemiologice. Acad Sci Mold. Med Sci. 2013;(4):230-234.
Armstrong LR, Derkay CS, Reeves WC. Initial results from the National Registry for Juvenile- Onset Recurrent Respiratory Papillomatosis. Arch Otolaryngol Head Neck Surg. 1999;125(7):743-8.
Derkay CS, Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope. 2008;118(7):1236-47.
Wiatrak BJ, Wiatrak DW, Broker TR, Lewis L. Recurrent respiratory papillomatosis: a longitudinal study. Laryngoscope. 2004;114(11):1883-91.
Syrjänen S. Human papillomavirus (HPV) in head and neck cancer. J Clin Virol. 2005;32 Suppl 1:S59-66.
Cabac V, Scutelnic L. Papilomatoza laringelui la copil: aspecte clinico-epidemiologice. Public Health Econ Manag Med (Chisinau). 2016;(2):157-160.
Katsenos S, Becker HD. Recurrent respiratory papillomatosis: a rare chronic disease, difficult to treat, with potential to lung cancer transformation. Lung. 2011;189(6):471-7.
Cernev D, Cabac V, Spinei L. Incidenţa și prevalenţa papilomatozei laringiene la copii în Republica Moldova. ORL.ro. 2024;(64):14.
Zeitels SM, Lopez-Guerra G, Burns JA, et al. Microlaryngoscopic and office-based injection of bevacizumab (Avastin) for recurrent respiratory papillomatosis. Ann Otol Rhinol Laryngol. 2009;118(6):418-26.
Rosenberg T, Philipsen BB, Mehlum CS, et al. Therapeutic use of HPV vaccines in recurrent respiratory papillomatosis: a systematic review. Int J Pediatr Otorhinolaryngol. 2019;123:124-31.
Cabac V, Parfeni V, Pojoga L, Sandul A. Unele aspecte ale papilomatozei laringiene la copil. Scientific Annals of Nicolae Testemitanu SUMPh. Chișinau: Medicina; 2008. Vol. 4. p. 218-223.
Fortes HR, von Ranke FM, Escuissato DL, Araujo Neto CA, Zanetti G, Hochhegger B, et al. Recurrent respiratory papillomatosis: a state-of-the-art review. Respir Med. 2017;126(116):116-21.
Welschmeyer A, Berke GS. An updated review of the epidemiological factors associated with recurrent respiratory papillomatosis. Laryngoscope Investig Otolaryngol. 2021;6(2):226-33.
Ovcinnikova O, Engelbrecht K, Verma M, Pandey R, Morais E. A systematic literature review of the epidemiology, clinical, economic and humanistic burden in recurrent respiratory papillomatosis. Respir Res. 2024 Dec 18;25(1):430.
Remacle M, et al. Endoscopic management of laryngeal precancerous lesions. Eur Arch Otorhinolaryngol. 2014;271(9):2461-71.
Peretti G, et al. Endoscopic management of laryngeal cancer and precancer. Curr Opin Otolaryngol Head Neck Surg. 2015;23(2):89-94.
Mallur PS, et al. Use of the microdebrider in laryngology. Laryngoscope. 2010;120(4):770-4.
Vilaseca I, et al. Open surgery for precancerous laryngeal lesions. Head Neck. 2016;38(Suppl 1):E1852-8.
Biel MA. Photodynamic therapy in head and neck cancer. Semin Oncol. 2019;46(4-5):306-14.
Lee JH, et al. Cidofovir therapy for recurrent respiratory papillomatosis: a meta-analysis. Laryngoscope. 2013;123(5):1236-43.
Ahn J, et al. Therapeutic HPV vaccines in head and neck cancer. Oral Oncol. 2018;82:108-12.
Ferris RL, et al. Immunotherapy in head and neck cancer. J Clin Oncol. 2015;33(29):3293-304.
Arens C, et al. Robotic and AI-assisted surgery in laryngeal disease. Front Oncol. 2020;10:1323.
Gale N, et al. Precancerous lesions of the larynx: diagnostic criteria and treatment. Histopathology. 2009;54(6):662-74.
Mehanna H, et al. Malignant transformation rates in oral and laryngeal precancer. Head Neck. 2009;31(12):1600-9.
Gerein V, et al. Malignant transformation of recurrent respiratory papillomatosis. Laryngoscope. 2005;115(2):313-7.
Laccourreye O, et al. Risk factors for recurrence and malignant transformation. Ann Otol Rhinol Laryngol. 2010;119(6):391-8.
Wiatrak BJ, et al. Recurrent respiratory papillomatosis: a long-term study. Laryngoscope. 2004;114(11 Pt 2 Suppl 104):1-20.
Morshed K. Association between p16, Ki-67 and HPV in laryngeal precancerous lesions. Eur Arch Otorhinolaryngol. 2015;272(11):3425-31.
Califano J, et al. Genetic progression model for head and neck cancer. Cancer Res. 1996;56(11):2488-92.
Cho WK, et al. Deep learning for histopathological diagnosis of laryngeal lesions. J Pathol Inform. 2021;12:15.
Ferris RL, et al. Immunology and immunotherapy of head and neck cancer. J Clin Oncol. 2015;33(29):3293-304.
Scutelnic L. Laringita de reflux: aspecte patogenetice, diagnostice şi de management. Bull Acad Sci Mold. Med Sci. Vol. 43 No. 2 (2014).
Tudor E., Cabac V., Budu AM., Cernev D., Osman V. Tuberculoza laringelui–aspecte de diagnostic și tratament. Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale 77 (3), 228-233.
Загрузки
Опубликован
Лицензия
Copyright (c) 2026 Вестник Академии Наук Молдовы. Медицина
Это произведение доступно по лицензии Creative Commons «Attribution» («Атрибуция») 4.0 Всемирная.
