Article record

按异型增生分级分层的声带白斑恶变率：系统评价与荟萃分析

Malignant Transformation Rates of Vocal Fold Leukoplakia Stratified by Dysplasia Grade: A Systematic Review and Meta-Analysis.

综述 Meta咽喉科IF 2Q2

文献信息

PMID	42954272
原文	在 PubMed 查看原文 ↗
发表日期	2026
作者	Rawaha Husam Al-Deen 查看其他 8 位作者 Shaahid Mohammed Ashraff；Mohammed Bilal Aziz；Humzah Hameed；Haleema Sadia Adil；Azfar Javed；Kalani Kuruppu；Hamad Khan；Farhan Ahsan
作者单位	Basildon University Hospital, Essex, UK. 查看其他 6 条单位信息 King's College London GKT School of Medical Education, London, UK.；Faculty of Medical Sciences, University College London, London, UK.；Manchester University NHS Foundation Trust, Manchester, UK.；St George's University Hospitals NHS Foundation Trust, London, UK.；Royal Stoke University Hospital, Ear, Nose and Throat, Stoke-on-Trent, UK.；New Cross Hospital, Wolverhampton, UK.
期刊	Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
SCI 分区	Q2
IF	2
研究类型	综述 Meta · 临床
所属专科	咽喉科

中文摘要

目的： 按异型增生分级对声带白斑恶变率进行系统评价，以支持临床随访策略和管理，并评估两级系统相对于既往三级系统的表现。
数据来源： PubMed、Embase、Scopus和Web of Science。
综述方法： 使用JBI批判性评价工具评估纳入研究的偏倚。从每项研究中提取恶变率及恶变时间。
结果： 共纳入30项研究，包含3714例异型增生病变患者。大多数研究使用WHO 2005分级，WHO 2017分级使用有限。对17项研究的荟萃分析显示，在WHO 2005分级下，轻度异型增生患者的恶变率为7.3%（95% CI：4.0%-10.6%），中度异型增生为19.2%（95% CI：12.4%-26.1%），重度异型增生或原位癌为29.4%（95% CI：21.4%-37.4%），均p < 0.001。重度异型增生的风险高于轻度（RR = 2.13；95% CI 1.67-2.71，p < 0.001）和中度异型增生（RR = 1.24；95% CI 1.01-1.52，p = 0.041）；中度高于轻度（RR = 1.68；95% CI 1.31-2.16，p < 0.001）。在WHO 2017分级下，高级别异型增生高于低级别异型增生（RR = 1.94；95% CI 1.55-2.42，p < 0.001）。
结论： 喉异型增生随分级增加，恶变风险更高，支持对较高级别进行更密切监测。在比较高级别与中度异型增生的RR时，中度异型增生保持其自身的风险特征，可认为2017系统丢失了一层随访。然而，由于中度异型增生呈现显著的风险特征，可以认为在新系统中将其归类为较高级别是有依据的。未来研究应标准化随访间隔和数据报告，并评估危险因素控制的效果。

英文摘要

OBJECTIVE: To perform a systematic review of rates of malignant transformation of vocal fold leukoplakia as per grades of dysplasia, to support clinician follow-up strategies and management and to make an assessment on the 2-tiered system against the previous 3-tiered system.
DATA SOURCES: PubMed, Embase, Scopus and Web of Science.
REVIEW METHODS: The JBI critical appraisal tool was used to assess included studies for bias. Rates of and time to malignant transformation were extracted from each study.
RESULTS: Thirty studies containing 3714 patients with dysplastic lesions were included. Most used WHO 2005 grading, with limited WHO 2017 use. Meta-analysis of 17 studies showed that under WHO 2005, malignant transformation occurred in 7.3% of patients with mild dysplasia (95% CI: 4.0%-10.6%), 19.2% of patients with moderate dysplasia (95% CI: 12.4%-26.1%) and 29.4% of patients with severe dysplasia or carcinoma in situ (95% CI: 21.4%-37.4%), all p < 0.001. Severe dysplasia carried a higher risk than mild (RR = 2.13; 95% CI 1.67-2.71, p < 0.001) and moderate dysplasia (RR = 1.24; 95% CI 1.01-1.52, p = 0.041); moderate exceeded mild (RR = 1.68; 95% CI 1.31-2.16, p < 0.001). Under WHO 2017, high-grade exceeded low-grade dysplasia (RR = 1.94; 95% CI 1.55-2.42, p < 0.001).
CONCLUSION: Laryngeal dysplasia is at greater risk of malignant transformation as the grade increases, supporting greater surveillance at higher grades. A layer of follow-up could be viewed as being lost in the 2017 system with moderate dysplasia maintaining its own risk profile when comparing RRs between high and moderate dysplasia. However, as moderate dysplasia presents a significant risk profile, it can be argued that classifying it as higher grade in the new system has credence. Future studies should standardise follow-up intervals and data reporting and assess the effect of risk-factor control.