Risk Factors Associated With Malignant Transformation in Patients With Oral Leukoplakia in a Chinese Population: A Retrospective Study

Abstract

Purpose: The study aim was to investigate the risk factors for the progression of oral leukoplakia (OLK) to malignancy.Patients and Methods: The data from 2,628 patients with OLK were retrospectively reviewed. Of these 2,628 patients, 192 had undergone sequential biopsies and were separated into 4 groups according to their final diagnosis. The risk factors were analyzed using Kaplan-Meier univariate survival analysis and Cox multivariate analysis.Results: In 41 of the 2,628 patients (1.7%), the OLK had progressed to cancer, with a mean interval to malignancy of 26.7 months. Of the 192 patients with sequential biopsies, OLK was maintained or had progressed to mild, moderate, or severe dysplasia or carcinoma in 50, 66, 35, and 41 patients, respectively. The 3-and 5-year oral cancer-free survival (OCFS) was 78.9 and 72.5%, respectively. The factors associated with worse overall survival were lesions located in the ventral tongue (P = .04), alcohol use (P = .025), nonhomogeneous lesions (P < .01), and high-risk dysplasia (P < .01). Cox regression analyses indicated that nonhomogeneous lesions (P = .03) and high-risk dysplasia (P < .01) were independent prognostic factors for the progression of OLK to malignancy.Conclusions: High-risk dysplasia and nonhomogeneous lesions were shown to be important factors for progression to malignancy in patients with OLK. Thus, such patients should receive close follow-up and undergo sequential biopsies in the first 2 to 3 years for early screening of OLK evolving into a malignancy.

Malignant transformation of oral leukoplakia: a multicentric retrospective study in Brazilian population

“…Our study also found that smoking was not a significant risk factor for OL malignancy, which is in line with other studies ( 9 , 20 ). Although there are similarities in the genetic alterations found in smokers and non-smokers whose cases suffered MT into oral squamous cell carcinoma ( 27 ), previous studies have described a significantly elevated risk for malignant progression in non-smokers ( 9 , 27 - 29 ), as we observed.…”

“…Considering the clinical subtype of OL, our findings are in line with the literature, confirming the high potential of MT of nonhomogenous leukoplakia ( 11 , 20 , 21 ). Although there is a consensus that PVL has a MT rate higher than 60% ( 9 , 11 , 22 ), we found a MT rate of only 8% among the cases described as PVL.…”

Oral tongue leukoplakia: analysis of clinicopathological characteristics, treatment outcomes, and factors related to recurrence and malignant transformation

“…c If a patient has other sites of oral leukoplakia in addition to tongue, the patient will be categorized as "yes" malignant changes of OLK, similar conflict between the published reports was also found; oral habits were significant factors in some academic works [5,29,39] and non-significant in others [21,38,[40][41][42]. In the present study, oral habits were not factors related to the recurrence or malignant transformation of oral tongue leukoplakia.…”

“…The relationship between a history of head and neck cancer in the context of postoperative recurrence and malignant transformation has been studied in several studies [23,[29][30][31][32]. In a cross-sectional study of prevalence and risk factors of carcinoma and dysplasia in 1046 patients with OLK in Taiwan, a history of head and neck cancer was not a factor related to the presence of dysplasia or carcinoma in the pathological diagnosis of OLK [16].…”

DEC1: a potential biomarker of malignant transformation in oral leukoplakia

“…2 According to its pathological features, OLK can be divided into epithelial hyperplasia or hyperkeratosis, with or without epithelial dysplasia. 3 The probability of malignant transformation of OLK was 0.13-17.5% in one study, which was proportional to the degree of epithelial cell dysplasia. 4 Oral epithelial cell dysplasia (OED) had malignant conversion rates of 6.6%-36.4%, which may increase the risk of OLK malignant transformation.…”