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The clinical determinants of malignant transformation in oral epithelial dysplasia

Ho, MW; Risk, JM; Woolgar, JA; Field, EA; Field, JK; Steele, JC; Rajalwat, BP; Triantafyllou, A; Rogers, SN; Lowe, D and Shaw, RJ (2012) The clinical determinants of malignant transformation in oral epithelial dysplasia. Oral Oncology, 48 (10). pp. 969-976. ISSN 1368-8375

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Abstract

Background: Wile the size and clinical appearance are known risk factors for malignant transformation of potentially malignant oral lesions, the site, grade of dysplasia and exposure to environmental carcinogens remains controversial. We aim to report the clinical determinants of malignant progression in a series of patients with histologically graded oral epithelial dysplasia (OED). Methods: We recruited patients with a histopathological diagnosis of OED to a longitudinal observational cohort study in a tertiary oral dysplasia clinic. Clinical, histopathological and risk factor data were recorded at baseline. One of three clinical endpoints were determined: malignant transformation, progression of dysplasia grade, remission / stable dysplasia grade. Results: Ninety-one patients meeting the criteria gave consent for inclusion to the cohort, with outcomes reported after a median follow up of 48 months. An estimated 22% (SE 6%) of patients underwent malignant transformation within 5 years, with significant predictors being: non-smoking status (χ2=15.1 p=0.001), site (χ2=15.3 p=0.002), non-homogeneous appearance (χ2=8.2 p=0.004), size of lesion >200mm2 (χ2=4.7, p=0.03) and, of borderline significance, high grade (χ2=5.8 p=0.06). Gender, age, number of lesions and alcohol history did not predict for malignant transformation. Conclusion: Although a number of these clinical determinants have previously been associated with higher malignant transformation in OED, the high risk nature of lesions in non-smokers is of particular note and requires a greater emphasis and recognition amongst clinicians dealing with OED. It suggests that those non-smokers with OED have an inherited or acquired predisposition and should be treated more aggressively; these should form the focus for further investigation.

Item Type:Article
Additional Information:Issue date: October 2012. Available online 10 May 2012. Error in reference numbering on uploaded document (28 references).
Uncontrolled Keywords:oral dysplasia; malignant transformation; smoking; oral squamous cell carcinoma
Subjects:R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RK Dentistry
Departments, Research Centres and Related Units:Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Cancer Studies
Academic Faculties, Institutes and Research Centres > Faculty of Medicine > School of Dental Sciences
DOI:10.1016/j.oraloncology.2012.04.002
Related URLs:
Refereed:Yes
Status:Published
ID Code:7693
Deposited On:05 Oct 2012 15:42
Last Modified:09 Oct 2012 15:10

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