Relationship between age at diagnosis and recurrence characteristics in adult-onset recurrent respiratory papillomatosis: a nationwide multicenter study from China
Year: 2025
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: To assess the demographic and clinical characteristics of Chinese adult-onset recurrent respiratory papillomatosis (AoRRP) and analyze the influence of age at diagnosis on recurrence. METHODS: Histologically confirmed AoRRP cases from 10 tertiary hospitals across China's 7 regions from 2011 to 2021 were analyzed. Demographic and clinical characteristics were summarized, recurrence probabilities (1-, 3-, 5-, and 7-year) were estimated by the Turnbull method, and early-course recurrence trajectories were identified using growth-mixture modelling (GMM). Associations between diagnostic age and recurrence were assessed using a generalized log-rank test, multivariable zero-inflated negative binomial regression, gamma regression, and multivariable logistic regression. RESULTS: Chinese AoRRP was diagnosed at a median age of 38 years, with peaks at 29 and 53 years; males accounted for 81.54% of cases. Hoarseness was the leading presenting symptom (85.54%). The median follow-up was 8.79 years (IQR = 5.50-11.23). Severe outcomes were observed, including aggressive AoRRP (9.85%), malignant transformation (2.46%), and mortality (0.62%). Overall, 65.85% of patients had at least one recurrence, and the recurrence density was 224.17 per 1,000 person-years. Of the four early-course recurrence trajectories identified by GMM, the persistent (18.75%) and early-burst (12.81%) types displayed frequent recurrences shortly after diagnosis. In multivariable analysis, each additional diagnostic year reduced the total number of recurrences (IRR = 0.97, 95% CI = 0.95-0.98) and made the early-course trajectory less severe (Persistent: OR = 0.89, 95% CI = 0.85-0.93; Early-Burst: OR = 0.91, 95% CI = 0.87-0.96). CONCLUSIONS: Chinese AoRRP patients showed a bimodal age at diagnosis. Recurrence exhibited marked heterogeneity, with the number and pattern of relapses varying widely among patients. Overall, a younger age at diagnosis was consistently linked to a substantially heavier recurrence burden.
Authors: Qijian Zheng, Changchang Dun, Wenbin Lei, Guangke Wang, Weiwei Wang, Qingquan Hua, Zhen Xu, Zhe Zhang, Dapeng Lei, Dongyan Chen, Xin Wang, Yalikun Yasen, Nilipaer Alimu, Li Shi, Xiaoguang Ni, Yutong Li, Jiayu Chen, Xuelian Zhao, Shangying Hu, Hui Yang, Jun Wang, Fanghui Zhao
Institutions: Chinese Academy of Medical Sciences & Peking Union Medical College, Lanzhou University, The First Affiliated Hospital, Sun Yat-sen University, Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou People's Hospital, Wuhan University, Renmin Hospital of Wuhan University, Guangxi Medical University, First Affiliated Hospital of GuangXi Medical University, Shandong University, Qilu Hospital of Shandong University, First Hospital of Jilin University, Xinjiang Medical University, First Affiliated Hospital of Xinjiang Medical University, Xijing Hospital, Air Force Medical University, Cancer Hospital of Chinese Academy of Medical Sciences, West China Hospital of Sichuan University, Beijing Tongren Hospital, Capital Medical University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,900
Awards: G217466333, G5059741843, G6481248584
OpenAlex ID: W4415226511