Objective: To determine possible predictive factors for clinically aggressive recurrent respiratory papillomatosis (RRP). Study Design: Retrospective cohort study at a tertiary academic medical center. Methods: Patients (adults and children) treated for RRP from 1998 to 2008 were identified using billing data and procedure logs. Cases were dichotomized into clinically aggressive versus non-aggressive disease. Aggressiveness was defined as: undergoing more than four procedures in twelve months, distal spread of disease, or transformation to squamous cell carcinoma. Results: Forty-four patients with RRP were identified. Age ranged from 4 months to 81 years old with 6 pediatric and 38 adult patients. There were 22 males and 22 females. Maximum number of surgical procedures in one year ranged from 1 to 13 (mean 3.4). Six patients had distal spread of disease and one suffered malignant transformation. Thirteen patients had aggressive disease and 31 patients had non-aggressive disease. Five patients had asthma. Pediatric patients were more likely to have aggressive disease (67% versus 24%, p=0.05). There was no association between GERD and aggressive disease, however patients not on PPI therapy were more likely to have aggressive disease (62% versus 16%, p=0.009). There was a strong association between asthma and aggressive RRP, with 100% of asthma patients having aggressive disease versus 21% of nonasthma patients (p=0.001). Conclusion: Asthma is associated with aggressive clinical course for RRP. Additional predictors of aggressive disease include lack of PPI use and pediatric disease onset. Patients with asthma may warrant closer clinical followup, and possible etiologic explanations for this finding are currently being investigated in our laboratory.
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