Elevated ASA class associated with malignant transformation in recurrent respiratory papillomatosis

Introduction Human papillomaviruses (HPV) 6 and 11 are causally associated with recurrent respiratory papillomatosis (RRP). Malignant transformation is rare. In this study, files of RRP patients were compared to identify risk factors for carcinoma development.

Methods Files of 63 RRP patients treated at the Kiel ENT Clinic from 2008 to 2021 were retrospectively reviewed. In the case that squamous cell carcinoma (SCC) developed in the head and neck region during the course of the disease, HPV status was determined in tissue samples from the RRP and SCC based on PCR. Results 8/63 patients developed laryngeal SCC (LSCC), and two others developed oral carcinoma. LSCC patients had a significantly higher number of comorbidities with appropriate medication even before cancer diagnosis. This was accompanied by a significantly higher ASA class, an assessment of anesthetic risk based on the patients’ physical condition. HPV11 and 16 could be detected in 2/8 LSCC. In addition, HPV6 could be determined in one of the RRP cases. HPV DNA and RNA were identical in all cases.

Discussion Elevated ASA class is significantly associated with the occurrence of LPEKA in RRP patients, this should be validated in larger groups. Intensified screening by HPV typing may be indicated. Isolation of HPV DNA/RNA fails in LSCC patients in 3 of 4 RRP samples despite positive housekeeping genes, possibly associated with the age of the Paraffin fixed material. It can be assumed that false-negative cases are found among HPV-negative SCC, thus questioning the reliability of studies on archived material. The detection of active HPV16 infection in one of the LSCC cases confirms the oncological role of HPV16 outside the oropharynx.

Publication History

Article published online:
12 May 2023