Malignant transformation of oral proliferative verrucous leukoplakia: A systematic review and meta‐analysis

Abstract

Objectives:To investigate the available evidence on the malignant transformation (MT) of oral proliferative verrucous leukoplakia (PVL). Material and Methods:We searched six main electronic and three grey literature databases in a two-phase process. Cohort studies investigating MT of PVL were eligible for inclusion. The risk of bias (RoB) was assessed using a specific tool developed by the Joanna Briggs Institute. Proportion meta-analyses were performed using a random-effects model. Results:Study selection resulted in the inclusion of 17 studies. The pooled proportion of MT was 43.87% (95% CI = 31.93-56.13). Females (64.02%, 95% CI = 54.87-72.75) were more affected by PVL than males (35.98%, 95% CI = 27.25-45.13). Gingiva (39.6%) and buccal mucosa (21.6%) were the most frequent PVL sites. No conclusive results were found between MT and sex or age distribution, tobacco, or alcohol consumption. Gingiva was the most common site for MT (39.9%), and the most frequent histopathological subtype was conventional squamous cell carcinoma (62.1%). Four studies were classified as low, nine as moderate, and four as high RoB. Conclusion:The MT pooled proportion was 43.87%. Among OPMDs, PVL has the highest risk to transform to malignancy. Development and agreement on diagnostic criteria for PVL would reduce the heterogeneity among future studies.

Oral epithelial dysplasia: Recognition, grading and clinical significance

“…Proliferative verrucous leukoplakia (PVL) is a distinct OPMD with oral leukoplakia at multiple intraoral sites and characterised by a progressive clinical course and associated with a high proportion of malignant transformation (Warnakulasuriya et al, 2020). A recent systematic review estimated the proportion to be 49.5% (CI 26.7%-72.4%) (Iocca et al, 2020), slightly lower (43.9%) in a further meta-analysis in this special issue (Ramos-García et al, 2021).…”

“…In the clinical context, it is used to describe the appearance of a group of conditions that resemble lichen planus, including lupus erythematosus, some drug reactions and graft-versus-host disease. It has also been proposed that oral 'lichenoid lesions' (defined as those with a mismatch between clinical and histological features) carry a higher risk of malignant transformation than lichen planus (van der Meij & van der Waal, 2003;Ramos-García et al, 2021) though this is disputed and confounded by terminological problems (González-Moles et al, 2021).…”

State of Evidence on Oral Health Problems in Diabetic Patients: A Critical Review of the Literature

“…Our research group has also reported the increased risk of development of oral potentially malignant disorders (OPMD) experienced by diabetic patients compared to the general population [12]. OPMDs are a significant group of mucosal disorders that may precede the diagnosis of oral squamous cell carcinoma (OSCC) [13,178], among which are essentially oral leukoplakia [179,180], oral lichen planus (OLP) [181][182][183], proliferative verrucous leukoplakia [184][185][186], erythroplakia, and actinic cheilitis [187,188]. Patients diagnosed with OPMDs may have an increased susceptibility to develop cancer anywhere in their mouth during their lifetime [13].…”

Oral potentially malignant disorders: Proceedings from an expert symposium

“…The subsequent five articles through systematic review and meta-analysis cover malignant transformation of a range of OPMDs (leukoplakia, proliferative verrucous leukoplakia, lichen planus and lichenoid reactions, and oral submucous fibrosis) providing the estimated proportions of OPMDs that transform to cancer (Table 1) (Aguirre-Urizar et al, 2021;Ramos-García et al 2021a;Ramos-García et al 2021b;González-Moles et al 2020;Kujan et al, 2020). As seen in Table 1, among OPMDs, proliferative verrucous leukoplakia (PVL) has the highest risk to transform to malignancy.…”