Recurrence in Oral Premalignancy: Clinicopathologic and Immunohistochemical Analysis

Abstract

Oral leukoplakia (OL) has a propensity for recurrence and malignant transformation (MT). Herein, we evaluate sociodemographic, clinical, microscopic and immunohistochemical parameters as predictive factors for OL recurrence, also comparing primary lesions (PLs) with recurrences. Thirty-three patients with OL, completely removed either by excisional biopsy or by laser ablation following incisional biopsy, were studied. Selected molecules associated with the STAT3 oncogenic pathway, including pSTAT3, Bcl-xL, survivin, cyclin D1 and Ki-67, were further analyzed. A total of 135 OL lesions, including 97 PLs and 38 recurrences, were included. Out of 97 PLs, 31 recurred at least once and none of them underwent MT, during a mean follow-up time of 48.3 months. There was no statistically significant difference among the various parameters in recurrent vs. non-recurrent PLs, although recurrence was most frequent in non-homogeneous lesions (p = 0.087) and dysplastic lesions recurred at a higher percentage compared to hyperplastic lesions (34.5% vs. 15.4%). Lower levels of Bcl-xL and survivin were identified as significant risk factors for OL recurrence. Recurrences, although smaller and more frequently homogeneous and non-dysplastic compared to their corresponding PLs, exhibited increased immunohistochemical expression of oncogenic molecules, especially pSTAT3 and Bcl-xL. Our results suggest that parameters associated with recurrence may differ from those that affect the risk of progression to malignancy and support OL management protocols favoring excision and close monitoring of all lesions.

Photodynamic therapy (PDT) for oral leukoplakia: a systematic review and meta-analysis of single-arm studies examining efficacy and subgroup analyses

“…This was done using photography and measurements. On the other hand, a histopathological diagnosis was conducted to determine whether there was any further deterioration [ 48 , 49 ]. The meta-analysis revealed that 13% of leukoplakia patients had recurrence after PDT treatment during the follow-up period.…”

Prevalence and Genotyping of HPV in Oral Squamous Cell Carcinoma in Northern Brazil

“…Since 1983, the increasing number of papers indicating a correlation between HPV infection with oropharyngeal tumors or lesions has increased [ 4 , 5 , 6 , 9 , 11 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 ]. The present study evaluated the prevalence of HR HPV using fresh and frozen biopsied samples; through various oral lesions (OL), OSCC was included and associated with patients’ sociodemographic parameters in northern Brazil.…”

“…OL were sub-divided in situ into benign lesions—traumatic fibroma, focal epithelial hyperplasia, pyogenic granuloma, papilloma, verruca vulgaris, condyloma acuminatum—and malignant or premalignant lesions: oral squamous cell carcinoma, leukoplakia, erythroplakia, oral lichen planus, oral submucous fibrosis and carcinoma. Although the main objective of the study is to associate HPV infection and SCC, both OL were biopsied, and benign lesions were used as a control group to evaluate HPV prevalence in different lesions [ 23 , 24 ].…”