An analysis of rate and factors affecting malignant transformation of oral submucous fibrosis in patients attending the Oral Medicine Clinic, Dental Hospital Peradeniya, Sri Lanka - A retrospective study

Abstract

Background: Oral submucous fibrosis (OSF) is a chronic, progressive, scarring and potentially malignant disease of the oral mucosa seen primarily in the Indian subcontinent and in South East Asia. OSF is a premalignant condition with a malignant transformation rate varying from 7-12%. Even though OSF and oral cancer are common in Sri Lanka, malignant transformation potential and rate have not been studied in our population. Objectives: To identify the relationship of malignant transformation with age, gender, habits, amount of mouth opening, duration of follow up, presence of other oral potentially malignant disorders and dysplasia in a group of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya. Methods: All the clinical files of patients with OSF attending the Oral Medicine clinic, University Dental Hospital Peradeniya were selected. Cases with OSF where histopathological diagnosis was not available, patients who had developed oral cancer before the diagnosis of OSF and patients who were diagnosed with OSF and received prior surgical therapy were excluded. Data were analysed to identify any relationship of malignant transformation with other variables. Results: There were 135 patients with a follow up period ranging from 6 months to 23 years and average follow up period was 5.26 years. 75.6% of them were males. 42.2% of them presented with burning sensation as the main complaint. 96.3% of them chewed betel with all ingredients whereas the rest chewed only arecanut. Eight patients developed malignancy during the follow up period giving a malignant transformation rate of 5.9% after a mean follow up period of 6.5 years. Conclusions: Malignant transformation in patients with OSF is significantly associated with presence of dysplasia on the initial biopsy, presence of any other potentially malignant disorder and the duration of betel chewing. _____________________________________________________________________________

Malignant transformation rate of oral submucous fibrosis: A systematic review and meta‐analysis

“…The studies included in this review were conducted in three different countries(India, Taiwan and Sri Lanka). Four studies have actually surveyed the population and followed them up 10,11,13,18 . Five studies obtained retrospective data of patients from the records and followed them up, 11,14–16,18 whilst one study reported information from records only 13 …”

“…Except for the two studies 11,12 where information was not provided, five studies reported malignant transformation to be more amongst males as compared to females 13–17 . The male to female ratio of 5:3 was mentioned in one study only 18 . The etiological factor as betel quid with tobacco was reported in two studies 10,15 whilst two other studies mentioned betel quid chewing habit along with alcohol consumption and/or smoking 17 .…”

“…Many population-based studies that followed up on OSF cases to assess its rate of transformation are widely published, reporting a MTR ranging from about 1.9% to 12%. [9][10][11][12][13][14][15][16][17][18] The aim of the current systematic review and meta-analysis is to summarize all the available data from the literature and derive a mean MTR of OSF.…”

“…Thus, it is of extreme significance to arrest the progression of OSF to oral squamous cell carcinoma (OSCC) with an early diagnosis. Many population‐based studies that followed up on OSF cases to assess its rate of transformation are widely published, reporting a MTR ranging from about 1.9% to 12% 9–18 . The aim of the current systematic review and meta‐analysis is to summarize all the available data from the literature and derive a mean MTR of OSF.…”

Comparative Evaluation of SMAD-2 Expression in Oral Submucous Fibrosis and Reactive Oral Lesions

“…The disease is witnessed in countries where the habit of betel chewing is recurrently practiced. The rate of malignant transformation is 7-13 % (Jayasinghe et al, 2016). Albeit the available epidemiological evidence implies that the chewing of areca nut is a definitive risk factor for progress of OSMF, imperceptibly chewers procure the disease and it is not a dose-response related disease.…”