Age at diagnosis, but not HPV type, is strongly associated with clinical course in recurrent respiratory papillomatosis.
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Buchinsky Farrel J, Valentino William L, Ruszkay Nicole, Powell Evan, Derkay Craig S, Seedat Riaz Y, Uloza Virgilijus, Dikkers Frederik G, Tunkel David E, Choi Sukgi S, Mortelliti Anthony J, Campisi Paolo, Ospina Juan C, Donne Adam J, Sataloff Robert T, Conley Stephen F, McClay John E, Friedman Ellen M, Elden Lisa, Tylor Dale A, Rosen Clark A, Smith Libby J, Copley Graeme J, Karas David E, Schweinfurth John M, Myer Charles M, Wiatrak Brian J, Dohar Joseph E, Sobol Steven E, Bastian Robert W, Smith Richard J H, Smith Marshall E, Wassie Abebe M, Post James C, Ehrlich Garth D
Аннотация
METHODS: A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics.
RESULTS: We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors.
CONCLUSION: In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.