Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients
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Oral leukoplakia (OL) is the best-known potentially malignant disorder. A new binary system to grade dysplasia was proposed by WHO, but the biological significance in predicting malignant transformation risk is unknown. The objective of this study is to estimate the rate of malignant transformation in a long-term follow-up cohort, explore the usefulness of the new binary system of grading dysplasia and identify significant risk factors of OL malignant transformation in China.A total of 218 patients with clinical and histopathologic diagnosis of OL were retrospectively reviewed. They were selected among all archived files at the Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The mean follow-up period was 5.3 years.Among 218 cases, 39 (17.9%) OL patients developed oral cancer, with a mean duration of 5.2 years. Cox regression analysis revealed that dysplasia was an independent risk factor for OL malignant transformation, but age, gender, lesion site, diet habit, smoking and ethanol intake were not risk factors. High-risk dysplastic OL was associated with a 4.57-fold (95% confidence interval, 2.36-8.84; P < 0.001) increased risk of malignant transformation, compared with low-risk dysplasia. Consistent with this result, high-risk dysplastic OL had significantly higher malignant incidence than low-risk dysplasia, particularly during the first 2-3 years of follow-up, by Kaplan-Meier analysis (Log-rank test, P < 0.001).The new binary system's function in predicting OL malignant transformation risk was investigated in this survey. The utilization of high-risk dysplasia as a significant indicator for evaluating malignant transformation risk in patients with OL was suggested, which may be helpful to guide treatment selection in clinical practice.Keywords:
Malignant Transformation
Abstract Oral leukoplakia and its malignant transformation are reviewed in this article. Oral leukoplakia is defined as a predominantly white lesion of the oral mucosa that can not be characterized as any other definable lesion; however, the lesion must be confirmed histopathologically by biopsy in order to discuss malignant transformation of oral leukoplakia. Malignant transformation rates of oral leukoplakia range from 0.13 to 17.5%, while the rates of five‐year cumulative malignant transformation range from 1.2 to 14.5%. Some reports found a high incidence of malignant transformation in older patients. Chewing tobacco and smoking are distinct risk factors particularly among males in certain countries; however, other countries have noted that females or non‐smokers may be at risk of malignant transformation. HPV has been detected in oral dysplasia lesions and cancer in non‐smokers. Conflicting reports have been presented regarding the malignant transformation of oral leukoplakia with epithelial dysplasia; however, we and some authors believe that epithelial dysplasia is an important factor in the malignant transformation of oral leukoplakia. The majority of researchers showed non‐homogenous leukoplakia as a risk factor, although different terms have been used to describe these lesions. There may be several routes to malignant transformation of oral leukoplakia, including transformations induced by carcinogenesis due to betel quid chewing or smoking, or by HPV infection. While no definite treatment modalities for oral leukoplakia have been established, we suggest surgical therapy with an adequate safety‐margin and well‐timed evaluation as an appropriate treatment in preventing malignant transformation.
Malignant Transformation
Epithelial dysplasia
Oral mucosa
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Malignant Transformation
Oral leukoplakia
Oral mucosa
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Two hundred fifty-seven patients with oral leukoplakia were studied and followed for an average period of 7.2 years. All lesions were more than one cm in size and had been present and observed for a minimum of 6 months. Of the initial biopsies, 235 revealed a benign hyperkeratosis and 22 others contained some degree of epithelial dysplasia. Seventy-three percent of the patients used tobacco, with cigarette usage being the predominant form. Forty-five patients (17.5%) subsequently developed squamous carcinomas in the hyperkeratotic epithelial site in an average time of 8.1 years. Eight of these malignant transformations came from patients who originally had epithelial dysplasia. High risks for malignant transformation also included non-smoking patients, the clinical presence of erythroplasia (erythroleukoplakia), and a clinical verrucous-papillary hyperkeratotic pattern. Duration of the leukoplakia progressively increased the total number of malignant transformations, with the largest rate occurring in the second year. This study confirms that oral leukoplakia is a precancerous lesion and that certain characteristics indicate greater risks and warrant consideration of more aggressive management.
Malignant Transformation
Epithelial dysplasia
Oral leukoplakia
Keratosis
Precancerous lesion
Premalignant lesion
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Background: oral leukoplakia is the most frequent premalignant lesion; it can appear with epithelial dysplasia that is the most important feature of its various histopathological changes. Morphometric and stereological methods allow complementing the conventional histopathological analysis of epithelial dysplasia. Objective: to characterize the lesions of the mucosa with oral leukoplakia according to the degree of epithelial dysplasia through morphometric and stereological indicators. Method: a descriptive, observational study was conducted. The universe was composed of 68 biopsies from patients with a histopathological and clinical diagnosis of leukoplakia; the sample was composed of 15 biopsies from patients with dysplastic leukoplakias in which morphometric and stereological parameters were analyzed. Results: it was found that as the degree of epithelial dysplasia becomes greater, the more the height of the epithelial crest and the height of the epithelium rise. The average value and its standard deviation of the shape factor in minor dysplasia was of 0.86 ± 0.08, in moderate dysplasia was of 0.88 ± 0.09, and in serious dysplasia was of 0.85 ± 0.11. As the dysplasia becomes greater, the average and the standard deviation of the nuclear volume and the density of epithelial nuclear profile decrease. Conclusions: from the analysis of the variables through this investigation, we can suggest the study and evaluation of the possibility of the existence of a model of nuclear volume-nuclear profile-height of the epithelium relation, as an instrument to determine the behavior of dysplasia. DeCS: LEUCOPLAKIA, ORAL; MOUTH MUCOSA; CELL NUCLEUS SHAPE; EPITHELIAL CELLS/pathology; EPHITELIUM/pathology
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To investigate the histological features of oral leukoplakia which underwent malignant transformation and its correlation with the clinical manifestation.A total of 1832 cases of oral leukoplakia were reviewed and the clinicopathological characteristics of malignant transformation were analyzed.Malignant transformation occurred in 85 cases (4.6%) of the 1832 cases. Thirty cases (2.1%) of 1404 cases with simple epithelial hyperplasia had malignant transformation. Fifty-five cases (12.9%) in 428 cases with epithelial dysplasia were transformed to malignancy, especially in the cases with moderate or severe dysplasia, in which the ratio of malignant transformation was higher than in the cases with simple epithelial hyperplasia (P < 0.005). Clinical parameters associated with an increased risk of malignant transformation were female gender and epithelial dysplasia was more often seen in non-homogenous leukoplakias than in homogenous (P < 0.005).Non-dysplastic leukoplakia may become malignant. Epithelial dysplasia was associated with an increased risk of malignant transformation. Leukoplakia in female may be at a higher risk for malignant transformation.
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Oral leukoplakia
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Leukoplakia is the most common potentially malignant disorder of the oral mucosa.The prevalence is approximately 1% while the annual malignant transformation ranges from 2% to 3%.At present, there are no reliable clinicopathological or molecular predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented.Furthermore, follow-up programs are of questionable value in this respect.Cessation of smoking habits may result in regression or even disappearance of the leukoplakia and will diminish the risk of cancer development either at the site of the leukoplakia or elsewhere in the mouth or the upper aerodigestive tract.The debate on the allegedly potentially malignant character of oral lichen planus is going on already for several decades.At present, there is a tendency to accept its potentially malignant behaviour, the annual malignant transformation rate amounting less than 0.5%.As in leukoplakia, there are no reliable predicting factors of malignant transformation that can be used in an individual patient and such event can not truly be prevented either.Follow-up visits, e.g twice a year, may be of some value.It is probably beyond the scope of most dentists to manage patients with these lesions in their own office.Timely referral to a specialist seems most appropriate, indeed.
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Oral leukoplakia
Oral mucosa
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Malignant Transformation
Oral leukoplakia
Epithelial dysplasia
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Epithelial dysplasia was examined clinico-pathologically in 196 cases of oral leukoplakia according to WHO's criteria. Fifty-seven cases (29.1%) were found to have epithelial dysplasia. The tongue was the most prevalent site at which epithelial dysplasia occurred, that is 31 of 66 case (47.0%). In 12 tems of WHO's criteria for epithelial dysplasia, the items 2, 1, 12 and 4 which were reported to be important to evaluate the potentiality of malignant transformation, were frequently seen in that order. Malignant transformation occurred in 14 cases (7.1%) of oral leukoplakia, in which the tongue was the most frequent site of malignant transformation (12 cases). Of the 14 cases, 7 showed epithelial dysplasia before malignant transformation. The cases whose grade of epithelial dysplasia had increased with time had a tendency to develop into cancer. Thus attention should be paid to the existence and grade of epithelial dysplasia in the treatment of oral leukoplakia.
Epithelial dysplasia
Malignant Transformation
Oral leukoplakia
Tongue Neoplasm
Premalignant lesion
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Malignant Transformation
Oral leukoplakia
Premalignant lesion
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Malignant Transformation
Epithelial dysplasia
Oral leukoplakia
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