Oral Cancer Development in Patients with Leukoplakia – Clinicopathological Factors Affecting Outcome

Abstract

BackgroundOral leukoplakia (OL) is the best-known potentially malignant disorder. The objective of the current study was to evaluate the clinicopathological factors predictive of outcome in a large cohort of patients with OL, and report our experience in the early detection of malignant events.MethodsA total of 320 patients with biopsy-proven OL were retrospectively reviewed from the study institution who had a mean follow-up of 5.1 years. Data on patient and lesion at initial diagnosis and patient underwent sequential biopsies were reviewed. Multiple biopsies indicates > = 3 times sequential biopsies. Oral cancer-free survival rate (OCFS) was determined by the Kaplan-Meier method and significant factors were identified by Cox regression analysis.ResultsThe 3-year and 5-year OCFS was 86.6% and 82.0%, respectively. A new binary system of grading oral dysplasia was performed and Kaplan-Meier analysis indicated that high-grade dysplasia had significantly higher malignant incidence than low-grade dysplasia (5-year OCFS, 90.5% vs 59.0%; P<0.001), especially during the first 2–3 years of follow-up. Multivariate analysis revealed that the 4 factors including patient aged >60 years, lesion located at lateral/ventral tongue, non-homogenous lesion, high-grade dysplasia were independent significant indicators for OL malignant transformation. In addition, significant positive correlation between the multiple biopsies and these 4 factors and malignant outcome was established.ConclusionsElderly patients with OL located at lateral/ventral tongue and who had non-homogenous lesion with high-grade dysplasia correlated much higher risk of transformation. This high-risk subpopulation was suggested to undergo sequential biopsies and histologic examination contributing to early detection of malignant event.

Levantamento epidemiológico de lesões orais potencialmente malignas em um centro de referência na Bahia

“…A leucoplasia é a lesão precursora de câncer mais prevalente da boca 9,25 , fato confirmado no presente estudo e no de Silveira et al 7 . Sua maior frequência no gênero feminino corrobora com Silveira et al 7 e Liu et al 25 , contudo, discorda com outros achados, como o de Liu et al 26 e Silva et al 27 .…”

“…Sua maior frequência no gênero feminino corrobora com Silveira et al 7 e Liu et al 25 , contudo, discorda com outros achados, como o de Liu et al 26 e Silva et al 27 . Quanto à cor de pele, a melanoderma foi a mais frequente, discordando com os autores Silveira et al 7 e Fernandes e Crivelini 28 , que evidenciaram maior predominância na raça/cor branca.…”

“…Quanto à cor de pele, a melanoderma foi a mais frequente, discordando com os autores Silveira et al 7 e Fernandes e Crivelini 28 , que evidenciaram maior predominância na raça/cor branca. Observou-se também maior número de casos a parti r dos 40 anos de idade, assim como observado por Silveira et al 7 , Liu et al 25 , a leucoplasia predominou na cor branca e nos ti pos fundamentais placa e mancha, também os mais encontrados por Fernandes e Crivelini 28 . Ocorreu mais no palato e na mucosa jugal, como visto nos estudos de Silva et al 27 e Fernandes e Crivelini 28 , apesar deste primeiro, ter sinalizado também a comissura labial, inclusive com similar predominância à mucosa jugal.…”

Advances in the Chemopreventive Targeting of Oral Carcinogenesis

“…Unfortunately, it is currently difficult to determine the risk of malignant transformation as more information needs to be gained from a lesional biopsy. For instance, a 5-year followup of patients who had been previously diagnosed with an oral leukoplakia showing high-grade dysplasia resulted in a higher OSCC incidence than those patients with low-grade dysplastic changes [15]. Overall, patients with leukoplakias with lowgrade dysplasia had a 5-year OSCC free survival rate of 90.5 % compared to only 59 % in patients with high-grade dysplastic lesions.…”

Oral Mukozanın Kanser Öncüsü Lezyonları

“…Örneğin Hindistan'dan yapılan çalışmalarda ters sigara içilmesi ve tütün çiğneme alışkanlığı nedeniyle bukkal mukoza ve labial komissuralardaki lökoplakiler daha riskli bildirilirken, genellikle Avrupa ülkeleri, Uzakdoğu ve ABD'den olan çalışmalarda, dil ve ağız tabanı malin transformasyon açısından daha yüksek riskli alanlar olarak bildirilmiştir. Çin'den yapılan 320 hastalık ve uzun izlem süresi (1-20 yıl) olan bir yayında; ileri yaş (>60 yaş), lateral ve ventral dil lokalizasyonu, homojen olmayan lökoplaki, şiddetli derecede displazi, yüksek kanser transformasyon riski ile ilişkili bulunmuştur 4 . Lökoplaki tipleri göz önüne alındığında, homojen olmayan lökoplakilerde OSHK gelişme sıklığı, homojen olanlara kıyasla oldukça yüksektir (homojen olmayan lökoplakilerde %20-25, homojen olanlarda ise %0,6-5) 5 .…”