Human papillomavirus type, proliferative activity, and p53 - Potential markers of aggressive papillomatosis

Context.-The predictive value of nuclear proliferation antigen (Ki-67), tum or suppressor gene product p53, and human papillomavirus type has not been evaluated for outcome of laryngeal papilloma. Objective.-This study was designed to determine whether immunohistochemical analysis of Ki-67 and p53 and human papillomavirus typing by polymerase ch ain reaction are able to identify patients with a more aggressive course of laryngeal papillomatosis. Design.-Immunohistochemistry and polymerase chain reaction were performed o n archival, paraffin-embedded, laryngeal papillomatosis biopsy specimens at the time of diagnosis, at an intermediate time during treatment, and at th e last procedure available. Staining indexes for Ki-67 and p53 were determi ned, and human papillomavirus type was analyzed for all biopsies. Patients.-Twelve patients with recurrent laryngeal papillomatosis for at le ast 5 years were selected from patients treated at our institution during t he last 20 years. Main Outcome Measures.-Separate analyses were conducted comparing average K i-67 and p53 indexes against disease outcome, viral type, or average number of procedures per year. Associations were analyzed between virus type, ave rage number of procedures per year, outcome, and histology. Results.-No statistically significant associations were noted in Ki-67 or p 53 indexes and outcome. Weak associations were noted for p53 indexes and pr ocedures per year and virus type. Weak associations also were noted between virus type and development of neoplasia. Conclusions.-Our observations suggest that human papillomavirus typing may be helpful in identifying patients with aggressive recurrent laryngeal papi llomatosis. The weak association between p53 indexes and procedures per yea r and virus type may have some predictive value in identifying aggressive l esions.