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Pimenta-Barros LA, Ramos-García P, González-Moles MÁ, Aguirre-Urizar JM, Warnakulasuriya S. Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis. Oral Dis 2024. [PMID: 39314164 DOI: 10.1111/odi.15140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/03/2024] [Accepted: 09/07/2024] [Indexed: 09/25/2024]
Abstract
OBJECTIVES To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility. MATERIALS AND METHODS MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value. RESULTS Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001). CONCLUSIONS OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.
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Affiliation(s)
| | - Pablo Ramos-García
- Instituto de Investigación Biosanitaria, School of Dentistry, University of Granada, Granada, Spain
| | | | - José Manuel Aguirre-Urizar
- Oral and Maxillofacial Medicine & Pathology Unit, Department of Stomatology, Faculty of Medicine and Nursery, University of the Basque Country/EHU, Leioa, Spain
| | - Saman Warnakulasuriya
- Faculty of Dental, Oral & Craniofacial Sciences, WHO Collaborating Centre for Oral Cancer, King's College London, London, UK
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Song Y, Tang F, Liu J, Yang D, Wang J, Luo X, Zhou Y, Zeng X, Xu H, Chen Q, Dan H. A complete course of photodynamic therapy reduced the risk of malignant transformation of oral leukoplakia. Photodiagnosis Photodyn Ther 2024:104338. [PMID: 39313101 DOI: 10.1016/j.pdpdt.2024.104338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/31/2024] [Accepted: 09/20/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND Photodynamic therapy (PDT) has shown good short-term efficacy in the treatment of oral leukoplakia (OLK). However, the malignant transformation of OLK was seldom evaluated in most PDT studies. Therefore, this study evaluated the effect of PDT on the risk of malignant transformation of OLK. METHODS Kaplan-Meier survival analysis, COX regression, and sensitivity analysis were used to evaluate the effects of PDT on the risk of malignant transformation of OLK. Subgroup analyses were performed to explore the role of PDT in OLK patients with different clinical characteristics. RESULTS OLK patients with older age (HR=1.032, P=0.018) and non-homogeneous lesion (HR=2.104, P=0.044) had higher risk of malignant transformation. Patients who had finished a complete course of PDT (HR=0.305, P=0.006) had a significant lower risk of malignant transformation, while those who hadn't finished a complete course of PDT (HR=0.692, P=0.352) cannot be considered to have such a protective effect. In the subgroup analyses, complete PDT course showed a significant protective effect on malignant transformation of OLK in patients with female sex, no smoking or drinking habits, non-homogeneous lesions, lesions on oral mucosa outside the dangerous region, and any grade of epithelial dysplasia. CONCLUSIONS A complete course of PDT could significantly reduce the risk of malignant transformation of OLK, especially in those patients with risk factors of malignant transformation.
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Affiliation(s)
- Yansong Song
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Fan Tang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Stomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou 310000, P.R. China
| | - Jiaxin Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Dan Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xiaobo Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China; Stomatology Hospital, School of Stomatology, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou 310000, P.R. China.
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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3
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Bhattarai BP, Singh AK, Singh RP, Chaulagain R, Søland TM, Hasséus B, Sapkota D. Recurrence in Oral Leukoplakia: A Systematic Review and Meta-analysis. J Dent Res 2024:220345241266519. [PMID: 39290142 DOI: 10.1177/00220345241266519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.
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Affiliation(s)
- B P Bhattarai
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - A K Singh
- Department of Oral and Maxillofacial Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - R P Singh
- Department of Oral and Maxillofacial Surgery, University Hospital Southampton, Southampton, UK
| | - R Chaulagain
- Department of Oral Biology, Chitwan Medical College, Bharatpur, Nepal
| | - T M Søland
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - B Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Sapkota
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
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Ko YCK, Liu KYP, Chen E, Zhu SY, Poh CF. p53-Abnormal Oral Epithelial Dysplasias Are Associated with High Risks of Progression and Local Recurrence - a Retrospective Study in a Longitudinal Cohort. Mod Pathol 2024:100613. [PMID: 39265950 DOI: 10.1016/j.modpat.2024.100613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 08/11/2024] [Accepted: 09/01/2024] [Indexed: 09/14/2024]
Abstract
Grading of oral epithelial dysplasia (OED) can be challenging with considerable intra- and inter-observer variability. Abnormal immunohistochemical staining patterns of the tumor suppressor protein, p53, have been recently shown to be potentially associated with progression in OED. We retrospectively identified 214 oral biopsies from 203 patients recruited in a longitudinal study between 2001 and 2008 with diagnosis of reactive, non-dysplastic lesions, low-grade lesions (LGLs; mild OED, moderate OED) and high-grade lesions (HGLs; severe OED /carcinoma in situ). Tissue microarrays (TMA) were constructed from the most representative area of the pathology. Three consecutive sections were sectioned and stained for hematoxylin and eosin, p53 immunohistochemistry, and p16 immunohistochemistry. The staining results were reviewed by two pathologists blinded to clinical outcome. Samples were categorized into p53-abnormal OED (n = 46), p53-conventional OED (n = 118), and p53-HPV (HPV-associated) OED (n = 12) using a previously published pattern-based approach. All cases of p53-HPV (HPV-associated) OED were identified in HGLs. In contrast, cases of p53-abnormal OED were observed in mild OED (9.5%), moderate OED (23%), and severe OED /carcinoma in situ (51%). None of the 27 reactive or non-dysplastic lesions showed abnormal p53 staining patterns. Among the 135 LGLs, 23 cases (17.0%; 2 mild OED and 21 moderate OED) progressed to HGL or squamous cell carcinoma, with 11 cases showing progression within the first 3 years. Remarkably, 82% (9/11) of these faster-progressors showed abnormal p53 patterns. Survival analysis revealed that p53-abnormal OED had significantly poorer progression-free probability (p<0.0001) with hazard ratio of 11.24 (95%CI, 4.26-29.66), compared to p53-conventional OED. Furthermore, p53-abnormal OED had poorer local-recurrence-free survival compared to p53 wild-type OED (p = 0.03). The study supports that OED with p53-abnormal pattern is at high-risk for progression and recurrence, independent of the dysplasia grade.
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Affiliation(s)
- Yen Chen Kevin Ko
- Department of Pathology, BC Cancer, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Oral Medical Biological Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Kelly Yi Ping Liu
- Department of Oral Medical Biological Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Integrative Oncology, BC Cancer, Vancouver, British Columbia, Canada; School of Biomedical Engineering, Faculty of Applied Science and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Esther Chen
- Department of Oral Medical Biological Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Yuqi Zhu
- Department of Oral Medical Biological Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Integrative Oncology, BC Cancer, Vancouver, British Columbia, Canada
| | - Catherine F Poh
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Oral Medical Biological Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada; Department of Integrative Oncology, BC Cancer, Vancouver, British Columbia, Canada
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Zhou X, Cai X, Tang Q, Zhang J, Bai J, Jing F, Gao L, Zhang H, Li T. Differences in the landscape of colonized microorganisms in different oral potentially malignant disorders and squamous cell carcinoma: a multi-group comparative study. BMC Microbiol 2024; 24:318. [PMID: 39223464 PMCID: PMC11367885 DOI: 10.1186/s12866-024-03458-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND The role of microbes in diseases, especially cancer, has garnered significant attention. However, research on the oral microbiota in oral potentially malignant disorders (OPMDs) remains limited. Our study investigates microbial communities in OPMDs. MATERIALS AND METHODS Oral biopsies from19 oral leukoplakia (OLK) patients, 19 proliferative verrucous leukoplakia (PVL) patients, 19 oral lichen planus (OLP) patients, and 19 oral lichenoid lesions (OLL) patients were obtained. 15 SCC specimens were also collected from PVL patients. Healthy individuals served as controls, and DNA was extracted from their paraffin-embedded tissues. 2bRAD-M sequencing generated taxonomic profiles. Alpha and beta diversity analyses, along with Linear Discriminant Analysis effect size analysis, were conducted. RESULTS Our results showed the microbial richness and diversity were significantly different among groups, with PVL-SCC resembling controls, while OLK exhibited the highest richness. Each disease group displayed unique microbial compositions, with distinct dominant bacterial species. Noteworthy alterations during PVL-SCC progression included a decline in Fusobacterium periodonticum and an elevation in Prevotella oris. CONCLUSIONS Different disease groups exhibited distinct dominant bacterial species and microbial compositions. These findings offer promise in elucidating the underlying mechanisms of this disease.
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Affiliation(s)
- Xuan Zhou
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China
| | - Xinjia Cai
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China
| | - Qian Tang
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, 410008, Hunan, China
| | - Jianyun Zhang
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China
| | - Jiaying Bai
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China
| | - Fengyang Jing
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China
| | - Li Gao
- Department of Periodontology, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Heyu Zhang
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China.
- Central Laboratory, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
| | - Tiejun Li
- Department of Oral Pathology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices& Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, No.22, Zhongguancun South Avenue, Haidian District, Beijing, 100081, PR China.
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, 100081, China.
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Celentano A, Cirillo N. Diseases with oral malignant potential: Need for change to inform research, policy, and practice. J Oral Pathol Med 2024; 53:495-501. [PMID: 39104084 DOI: 10.1111/jop.13573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 07/09/2024] [Accepted: 07/17/2024] [Indexed: 08/07/2024]
Abstract
This manuscript critically examines the current classification of oral potentially malignant disorders, questioning the practicality and implications of labeling such a large population as precancerous, given that the actual progression to oral cancer is significantly low for most disorders. The paper advocates for a revised classification system that accurately reflects the varying malignancy risks associated with different disorders. It suggests a reassessment of the diagnostic and management approaches to mitigate overdiagnosis and alleviate patient burdens. We propose categorizing diseases with oral malignant potential as follows: Oral Precancerous Diseases, encompassing high-risk lesions and conditions like erythroplakia, non-homogeneous leukoplakia, proliferative leukoplakia, and actinic keratosis; Oral Potentially Premalignant Diseases, covering lesions, conditions, and systemic diseases with distinct oral manifestations harboring a limited or undefined risk of transformation, such as homogeneous leukoplakia, oral submucous fibrosis, oral lichenoid diseases, chronic hyperplastic candidosis, keratosis of known aetiology (smokeless tobacco, khat), palatal lesions in reverse smokers, and dyskeratosis congenita; and Systemic Conditions with Oral Malignant Potential including Fanconi's anemia, xeroderma pigmentosum, and chronic immunosuppression (including patients post-bone marrow transplantation), which are associated with an increased risk of oral cancer without preceding precursor lesions. We provide illustrative examples to demonstrate how this framework offers practical guidance for research, policy-making, and clinical practice.
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Affiliation(s)
- Antonio Celentano
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Nicola Cirillo
- Melbourne Dental School, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville, Victoria, Australia
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Pedroso CM, do Santos ES, Alves FA, Martins MD, Kowalski LP, Lopes MA, Warnakulasuriya S, Villa A, Santos-Silva AR. Surgical protocols for oral leukoplakia and precancerous lesions across three different anatomic sites. Oral Dis 2024. [PMID: 39155483 DOI: 10.1111/odi.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 06/24/2024] [Accepted: 07/26/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to compare the risk of recurrence and cancer progression after surgical treatment for oral potentially malignant disorders (OPMD) and precancerous lesions in different anatomical sites. MATERIALS AND METHODS A comprehensive search was conducted in nine databases and grey literature. We included randomized controlled trials assessing surgical treatment efficacy for OPMD and precancerous lesions of cervical, vaginal, anal, and penile sites. Excision or ablation surgical treatments were considered. RESULTS Overall, 12 studies met the eligibility criteria for oral leukoplakia (OL), proliferative verrucous leukoplakia, cervical intraepithelial neoplasia (CIN), vaginal intraepithelial neoplasia, and anal intraepithelial neoplasia (AIN). In qualitative analysis of surgical protocols, the lack of margin description impacts the clinical outcomes of OL and AIN, and the ablative protocols were heterogeneous in both OPMD and precancerous lesions. No significant difference in OL (risk ratio 0.82 [95% CI: 0.59-1.15]) and CIN (risk ratio 0.31 [95% CI: 0.09-1.09]) for recurrence was observed when cold-knife was compared with ablative protocols. OL exhibited higher recurrence and cancer progression rates compared to CIN and AIN. CONCLUSION There is no difference in recurrence risk post-surgical treatment for OL and CIN. Surgical protocols for oral leukoplakia and CIN/AIN lack standardized approaches.
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Affiliation(s)
- Caique Mariano Pedroso
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Erison Santana do Santos
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Fábio Abreu Alves
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
- Department of Stomatology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Manoela Domingues Martins
- Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Luiz Paulo Kowalski
- Head and Neck Surgery Department, Medical School, Universidade de São Paulo - USP, São Paulo, SP, Brazil
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, SP, Brazil
| | - Marcio Ajudarte Lopes
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
| | - Saman Warnakulasuriya
- The WHO Collaborating Centre for Oral Cancer, Lyon, France
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Alessandro Villa
- Miami Cancer Institute, Baptist Health South Florida, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, State University of Campinas, Piracicaba, Brazil
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Soares AC, Gomes APN, Calderipe CB, Salum FG, Cherubini K, Martins MD, Schuch LF, Kirschnick LB, Abreu LG, Santos-Silva AR, Vasconcelos ACU. Oral leukoplakia and erythroplakia in young patients: a southern Brazilian multicenter study. Braz Oral Res 2024; 38:e069. [PMID: 39109766 PMCID: PMC11376665 DOI: 10.1590/1807-3107bor-2024.vol38.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/06/2024] [Indexed: 09/20/2024] Open
Abstract
The objective of the present study was to investigate the frequency of oral leukoplakia and oral erythroplakia among young patients from three Brazilian reference centers in Oral and Maxillofacial Pathology. A retrospective study was carried out from 2011 to 2021 on 861 patients diagnosed with oral leukoplakia and oral erythroplakia. Demographic and clinicopathological data were evaluated. Fisher's exact test was used to evaluate the association among sex, age, anatomical location, and histopathological diagnosis. A total of 83 (9.64%) cases involved young patients (aged <40 years). Among these, biopsy records were included in 31 (37.34%) cases, all of which received a clinical diagnosis of oral leukoplakia. Seventeen (54.84%) patients were female, mostly in their fourth decade of life (n = 22/70.97%), and their mean age at diagnosis was 32.61(± 5.21) years. Among informed cases, seven (22.58%) patients were smokers. The lateral border of the tongue (n = 9/29.03%) was the most affected site. In 13 (41.94%) cases, oral leukoplakias showed a homogeneous appearance. The mean size of the lesions was 1.47 cm (0.2-3.0 cm) and the mean time of disease progression was 64.37 (± 65.90) months. The histopathological analysis showed that 11 cases (35.48%) exhibited some degree of epithelial dysplasia. Acanthosis and/or hyperkeratosis were observed in 20 cases (64.52%). No significant associations were observed between sex and anatomical location, age and anatomical location, nor between sex and histological diagnosis (p > 0.05). Oral leukoplakia and oral erythroplakia are uncommon diseases in young patients. In this population, oral leukoplakia shows a slight predilection for women aged between 30 and 39 years.
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Affiliation(s)
- Alini Cardoso Soares
- Universidade Federal de Pelotas - UFPel, Dental School, Diagnostic Center for Oral Diseases, Pelotas, RS, Brazil
| | - Ana Paula Neutzling Gomes
- Universidade Federal de Pelotas - UFPel, Dental School, Diagnostic Center for Oral Diseases, Pelotas, RS, Brazil
| | - Camila Barcellos Calderipe
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Fernanda Gonçalves Salum
- Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Division of Oral Medicine, Porto Alegre, RS, Brazil
| | - Karen Cherubini
- Pontifícia Universidade Católica do Rio Grande do Sul - PUCRS, Division of Oral Medicine, Porto Alegre, RS, Brazil
| | - Manoela Domingues Martins
- Universidade Federal do Rio Grande do Sul - UFRGS, School of Dentistry, Department of Oral Pathology, Porto Alegre, RS, Brazil
| | - Lauren Frenzel Schuch
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Laura Borges Kirschnick
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
| | - Lucas Guimarães Abreu
- Universidade Federal de Minas Gerais - UFMG, School of Dentistry, Department of Child and Adolescent Oral Health, Belo Horizonte, MG, Brazil
| | - Alan Roger Santos-Silva
- Universidade Estadual de Campinas - Unicamp, Piracicaba Dental School, Department of Oral Diagnosis, Piracicaba, SP, Brazil
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9
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Wang F, Song Y, Xu H, Liu J, Tang F, Yang D, Yang D, Liang W, Ren L, Wang J, Luo X, Zhou Y, Zeng X, Dan H, Chen Q. Prediction of the short-term efficacy and recurrence of photodynamic therapy in the treatment of oral leukoplakia based on deep learning. Photodiagnosis Photodyn Ther 2024; 48:104236. [PMID: 38851310 DOI: 10.1016/j.pdpdt.2024.104236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND The treatment of oral leukoplakia (OLK) with aminolaevulinic acid photodynamic therapy (ALA-PDT) is widespread. Nonetheless, there is variation in efficacy. Therefore, this study constructed a model for predicting the short-term efficacy and recurrence of OLK after ALA-PDT. METHODS The short-term efficacy and recurrence of ALA-PDT were calculated by statistical analysis, and the relevant influencing factors were analyzed by Logistic regression and COX regression model. Finally, prediction models for total response (TR) rate, complete response (CR) rate and recurrence in OLK patients after ALA-PDT treatment were established. Features from pathology sections were extracted using deep learning autoencoder and combined with clinical variables to improve prediction performance of the model. RESULTS The logistic regression analysis showed that the non-homogeneous (OR: 4.911, P: 0.023) OLK and lesions with moderate to severe epithelial dysplasia (OR: 4.288, P: 0.042) had better short-term efficacy. The area under receiver operating characteristic curve (AUC) of CR, TR and recurrence predict models after the ALA-PDT treatment of OLK patients is 0.872, 0.718, and 0.564, respectively. Feature extraction revealed an association between inflammatory cell infiltration in the lamina propria and recurrence after PDT. Combining clinical variables and deep learning improved the performance of recurrence model by more than 30 %. CONCLUSIONS ALA-PDT has excellent short-term efficacy in the management of OLK but the recurrence rate was high. Prediction model based on clinicopathological characteristics has excellent predictive effect for short-term efficacy but limited effect for recurrence. The use of deep learning and pathology images greatly improves predictive value of the models.
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Affiliation(s)
- Fei Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yansong Song
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Hao Xu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Jiaxin Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Fan Tang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China; Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou 310000, PR China
| | - Dan Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Dan Yang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Wenhui Liang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Ling Ren
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Xiaobo Luo
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yu Zhou
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Xin Zeng
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Qianming Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan 610041, PR China; Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Cancer Center of Zhejiang University, Hangzhou 310000, PR China.
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10
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Xu M, Sun Y, Cong B, Zhang X, Li Z, Liu Y, Geng L, Qin Q, Wu Y, Gao M, Wang W, Wang Y, Xu Y. The mechanism of low molecular weight fucoidan-incorporated nanofiber scaffolds inhibiting oral leukoplakia via SR-A/Wnt signal axis. Front Pharmacol 2024; 15:1397761. [PMID: 39104391 PMCID: PMC11298705 DOI: 10.3389/fphar.2024.1397761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 07/01/2024] [Indexed: 08/07/2024] Open
Abstract
Oral leukoplakia (OLK) is the most common oral precancerous lesion, and 3%-17% of OLK patients progress to oral squamous cell carcinoma. OLK is susceptible to recurrence and has no effective treatment. However, conventional drugs have significant side effects and limitations. Therefore, it is important to identify drugs that target OLK. In this study, scavenger receptor A (SR-A) was found to be abnormally highly expressed in the oral mucosal epithelial cells of OLK patients, whereas molecular biology studies revealed that low molecular weight fucoidan (LMWF) promoted apoptosis of dysplastic oral keratinocytes (DOK) and inhibited the growth and migration of DOK, and the inhibitory effect of LMWF on OLK was achieved by regulating the SR-A/Wnt signaling axis and related genes. Based on the above results and the special situation of the oral environment, we constructed LMWF/poly(caprolactone-co-lactide) nanofiber membranes with different structures for the in-situ treatment of OLK using electrospinning technology. The results showed that the nanofiber membranes with a shell-core structure had the best physicochemical properties, biocompatibility, and therapeutic effect, which optimized the LMWF drug delivery and ensured the effective concentration of the drug at the target point, thus achieving precise treatment of local lesions in the oral cavity. This has potential application value in inhibiting the development of OLK.
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Affiliation(s)
- Ming Xu
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yu Sun
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Beibei Cong
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Xiaopei Zhang
- Institute of Neuroregeneration & Neurorehabilitation, Department of Pathophysiology, School of Basic Medicine, Qingdao Medical College, Qingdao University, Qingdao, China
| | - Zhenfeng Li
- Experimental Center for Medical Research, Weifang Medical University, Weifang, China
| | - Yingnan Liu
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Lihua Geng
- CAS and Shandong Province Key Laboratory of Experimental Marine Biology, Center for Ocean Mega-Science, Institute of Oceanology, Chinese Academy of Sciences, Qingdao, China
| | - Qi Qin
- Qingdao Medical College, Qingdao University, Qingdao, China
| | - Yingtao Wu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Meihua Gao
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Wanchun Wang
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Yuanfei Wang
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
| | - Yingjie Xu
- Qingdao Stomatological Hospital Affiliated to Qingdao University, Qingdao, China
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11
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Adeoye J, Su YX. Validity of nomograms for predicting cancer risk in oral leukoplakia and oral lichen planus. Oral Dis 2024; 30:3039-3051. [PMID: 38009867 DOI: 10.1111/odi.14811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/27/2023] [Accepted: 11/04/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES This study assessed the validity of nomograms for predicting malignant transformation (MT) among patients with oral leukoplakia (OL) and oral lichen planus (OLP). MATERIALS AND METHODS Two nomograms were identified following a systematic search. Variables to interrogate both nomograms were obtained for a retrospective OL/OLP cohort. Then, the nomograms were applied to estimate MT probabilities twice and their average was used to calculate the discriminatory performance, calibration, and potential net benefit of the models. Subgroup analyses were performed for patients with OL, OLP, and oral epithelial dysplasia. RESULTS Predicted probabilities were mostly significantly higher among OL/OLP patients who developed MT compared to those who did not (p = <0.001-0.034). AUC values and Brier scores of the nomograms were 0.644-0.844 and 0.040-0.088 among OL patients and 0.580-0.743 and 0.008-0.072 among OLP patients. Decision curve analysis suggested that the nomograms had some net benefit for risk stratification. However, the models did not best binary dysplasia grading in discriminatory validity and net benefit among patients with OL and oral epithelial dysplasia. CONCLUSION Nomograms for predicting MT may have satisfactory validity among patients with OL than OLP, but they do not outperform binary dysplasia grading in risk stratification of OL.
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Affiliation(s)
- John Adeoye
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR
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12
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Evren I, Najim AM, Poell JB, Brouns ER, Wils LJ, Peferoen LAN, Brakenhoff RH, Bloemena E, van der Meij EH, de Visscher JGAM. The value of regular follow-up of oral leukoplakia for early detection of malignant transformation. Oral Dis 2024; 30:2991-3003. [PMID: 37936517 DOI: 10.1111/odi.14797] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/07/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES Evaluate whether regular follow-up of oral leukoplakia (OL) resulted in early detection of malignant transformation (MT). METHOD Two hundred and twenty-two consecutive patients with OL (147 females, 75 males); median follow-up period of 64 months (range: 12-300). Three groups were distinguished: group A (n = 92) follow-up at the hospital; group B (n = 84) follow-up by their dentist; group C (n = 46) lost to follow-up. RESULTS OLs in group B compared to group A, were smaller in size (<2 cm; p < 0.001), showed more hyperkeratosis (p < 0.001) and less moderate/severe dysplasia (p < 0.001). MT occurred in 45 (20%) patients: 32 (35%) in group A, five (6%) in group B and eight (17%) in group C. There was no significant difference in clinical tumour size between group A (median: 15 mm, range: 1-40) and group B (median: 10 mm, range: 3-25; p = 0.496). Tumour size was smaller for patients in groups A and B (median: 10 mm, range 1-40) compared to group C (median: 33 mm, range: 3-100; p = 0.003). There was a positive correlation between tumour size and interval between the last visit in all patients (p = 0.022). CONCLUSION Regular follow-up of OL resulted in early detection of MT. If properly selected, follow-up of OL performed by the dentist seems feasible.
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Affiliation(s)
- Ilkay Evren
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ahmad M Najim
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jos B Poell
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Elisabeth R Brouns
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Leon J Wils
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Laura A N Peferoen
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Cancer Centre Amsterdam, Imaging and Biomarkers, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Erik H van der Meij
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jan G A M de Visscher
- Department of Oral and Maxillofacial Surgery/Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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13
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Lombardi N, Arduino PG, Lampiano M, Gambino A, Broccoletti R, Varoni EM, Lodi G. Surgical treatment compared with "wait and see" in patients affected by oral leukoplakia to prevent oral cancer: Preliminary data from a multicenter randomized controlled trial. Oral Dis 2024. [PMID: 38938085 DOI: 10.1111/odi.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/27/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Oral leukoplakia (OL) is one of the most common and investigated oral potentially malignant disorders (OPMD). Preventing OSCC occurrence should be the primary outcome in the clinical management of OL. Surgical removal of OL is performed by most clinicians, although its effectiveness in reducing OSCC onset has still not been established by randomized controlled trials (RCT). Wait and see approach is characterized by frequent clinical examinations and periodical biopsies of OL, avoiding unnecessary surgical procedures. This is the first multicenter RCT in literature aiming at comparing the effectiveness of surgical removal and the "wait and see" approach in preventing OSCC onset in patients affected by dysplastic and non-dysplastic OL. METHODS Two Italian referral care centres for oral diseases were involved in this multicenter two-arm RCT comparing the surgical removal of OL (group A) and the "wait and see" approach (group B), with the aim of reducing oral cancer onset. RESULTS This report shows preliminary data on the first 161 patients, with a mean follow-up of 19.14 ± 11.25 months. Eight cases of OSCC occurred (6 out 8 involving the tongue): one case in group A and seven cases in group B. Moreover, OL recurred in 13 (20%) cases after surgical excision. CONCLUSIONS Within the limitations of this preliminary report, these initial data underline the increased risk of OSCC onset in the case of OL of the tongue in the presence of epithelial dysplasia in group B ("wait and see") compared to group A (surgery). This RCT is currently ongoing at the same clinical departments, with the aim of enrolling 310 patients and collecting data at 5-year follow-up, in order to achieve conclusive results, in an evidence-based medicine approach.
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Affiliation(s)
- Niccolò Lombardi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
- ASST Santi Paolo e Carlo, SC Odontostomatologia II, Ospedale San Paolo, Milan, Italy
| | - Paolo G Arduino
- Dipartimento di Scienze Chirurgiche, CIR Dental School, Università Degli Studi di Torino, Turin, Italy
| | - Marta Lampiano
- Dipartimento di Scienze Chirurgiche, CIR Dental School, Università Degli Studi di Torino, Turin, Italy
| | - Alessio Gambino
- Dipartimento di Scienze Chirurgiche, CIR Dental School, Università Degli Studi di Torino, Turin, Italy
| | - Roberto Broccoletti
- Dipartimento di Scienze Chirurgiche, CIR Dental School, Università Degli Studi di Torino, Turin, Italy
| | - Elena M Varoni
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
- ASST Santi Paolo e Carlo, SC Odontostomatologia II, Ospedale San Paolo, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università Degli Studi di Milano, Milan, Italy
- ASST Santi Paolo e Carlo, SC Odontostomatologia II, Ospedale San Paolo, Milan, Italy
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14
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Herreros-Pomares A, Hervás D, Bagán L, Proaño A, Bagan J. Proliferative verrucous and homogeneous Leukoplakias exhibit differential methylation patterns. Oral Dis 2024. [PMID: 38852153 DOI: 10.1111/odi.15028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/20/2024] [Accepted: 05/20/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVE Proliferative verrucous leukoplakia (PVL) is considered a clinically distinct entity from other oral leucoplakias (OLs) due to its clinical presentation and evolution. However, molecular differences between them remain unclear. We aimed to determine whether there are methylation differences between PVL and other forms of OLs. MATERIALS AND METHODS Oral biopsies from 12 patients with PVL, eight patients with homogeneous leucoplakia (HL), and 10 healthy individuals were obtained for a genome-wide DNA methylation analysis via the Infinium EPIC Platform. RESULTS A total of 1815 differentially methylated CpGs were found between PVL and HL, with a prominent state of hypermethylation in HL patients. CpGs covered 813 genes with distinct roles, including cell adhesion, extracellular matrix organization, and cell and synaptic signaling. 43% of these genes had been previously described in cancer and associated with prognosis. We developed a multinomial logistic regression model able to differentiate HL, PVL, and control samples. The model had a cross-validated estimate of 73% and included differentially methylated cancer-related genes between the pathological conditions and the healthy donors, including ADNP, BRCA2, CDK13, GNB1, NIN, NUMB, PIK3C2B, PTK2, SHISA4, THSD7B, WWP1, and ZNF292. It also included CpGs covering differentially methylated genes in HL (MEN1 and TNRC6B) and PVL (ACOXL, ADH1B, CAMTA1, CBFA2T3, CPXM2, LRFN2, SORCS2, and SPN). CONCLUSIONS PVL and HL present differential methylation patterns that could be linked to their differential clinical behavior. Our findings show the potential of methylation markers and suggest novel diagnostic biomarkers.
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Affiliation(s)
- Alejandro Herreros-Pomares
- Department of Biotechnology, Universitat Politècnica de València, Valencia, Spain
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain
| | - David Hervás
- Departament of Applied Statistics and Operational Research, and Quality, Universitat Politècnica de València, Valencia, Spain
| | - Leticia Bagán
- Medicina Oral Unit, Stomatology Department, Valencia University, Valencia, Spain
| | - Alex Proaño
- Medicina Oral Unit, Stomatology Department, Valencia University, Valencia, Spain
| | - José Bagan
- Centro de Investigación Biomédica en Red Cáncer, CIBERONC, Madrid, Spain
- Medicina Oral Unit, Stomatology Department, Valencia University, Valencia, Spain
- Department of Stomatology and Maxillofacial Surgery, Hospital General Universitario de Valencia, Valencia, Spain
- Precancer and Oral Cancer Research Group of Valencia University, Valencia, Spain
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15
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Piemonte ED, Gilligan GM, Garola F, Lazos JP, Panico RL, Normando AGC, Santos-Silva AR, Warnakulasuriya S. Differences among oral carcinomas arising de novo from those associated with oral potentially malignant disorders: a systematic review and meta-analysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:613-631. [PMID: 38609795 DOI: 10.1016/j.oooo.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/14/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To analyze the frequency of sequential oral squamous cell carcinomas (s-OSCC), preceded by oral potentially malignant disorders, and OSCC de novo (OSCC-dn) and explore differences in their clinicopathologic presentations. STUDY DESIGN A structured electronic search strategy identified studies that analyzed frequency, clinical, biological, demographic, biomarkers, and prognostic features of s-OSCC and OSCC-dn according to PRISMA guidelines in PubMed, Scopus, Cochrane Library, and Google Scholar, up to January 31, 2023. Inclusion criteria were original English, Spanish, Portuguese, French, Italian, and German cross-sectional, cohort, and case-control studies. The quality of studies was assessed using the Agency for Research and Health Quality tool and the Newcastle-Ottawa Scale tool. RESULTS The final selection included 40 studies. OSCC-dn and s-OSCC represent, respectively, 71% and 29% of cases of OSCC (P = .00), showing a higher percentage of T1 or of T1+T2 in s-OSCC (P < .0001). The association meta-analysis showed OSCC-dn with a significant association. The meta-analysis showed that s-OSCC was significantly associated with smaller tumor size, absence of distant metastases, relapses, male sex, and tumor sites different from tongue; and OSCC-dn was associated with more advanced tumor size, more regional and distant metastases, more advanced stages, and worse survival. CONCLUSIONS S-OSCC was less frequent than expected. OSCC-dn seems to have specific clinical, biological, and prognostic features. Future perspectives on oral cancer prevention should address novel approaches and alternatives to screening, such as urgent referral of OSCC-dn.
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Affiliation(s)
- Eduardo David Piemonte
- Oral Medicine Department, Dentistry College, Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Gerardo Marcelo Gilligan
- Oral Medicine Department, Dentistry College, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Federico Garola
- Oral Medicine Department, Dentistry College, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Jerónimo Pablo Lazos
- Oral Medicine Department, Dentistry College, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - René Luis Panico
- Oral Medicine Department, Dentistry College, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Ana Gabriela Costa Normando
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
| | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, SP, Brazil
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16
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Zhang C, Lan Q, Wei P, Gao Y, Zhang J, Hua H. Clinical, histopathological characteristics and malignant transformation of proliferative verrucous leukoplakia with 36 patients: a retrospective longitudinal study. BMC Oral Health 2024; 24:639. [PMID: 38816724 PMCID: PMC11138006 DOI: 10.1186/s12903-024-04360-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Proliferative verrucous leukoplakia (PVL), distinguished by its malignant transformation rate of 43.87% to 65.8%, stands as the oral potentially malignant disorder with the highest propensity for malignancy. PVL is marked by distinctive heterogeneity regarding the clinical or histopathological characteristics as well as prognostic factors pertinent to this condition. The purpose of this study is to compile and assess the clinicopathological features, malignant transformation, and associated risk factors in patients diagnosed with PVL. METHODS This study is a hospital-based retrospective longitudinal study of 36 patients diagnosed with PVL from 2013 to 2023. We conducted complete clinical and histopathological evaluations of the patients. RESULTS The cohort comprised 16 males and 20 females, yielding a male-to-female ratio of 1:1.25. The follow-up period ranged from 8 to 125 months, with an average of 47.50 months. The most common clinical type of lesion was the verrucous form (58.33%), and the gingiva was the most common site (44.44%). Each patient had between 2 to 7 lesions, averaging 3.36 per patient. During the follow-up period, twelve patients (33.3%) developed oral cancer, with an average time to malignant transformation of 35.75 months. Kaplan-Meier survival analysis indicated that patients with complaints of pain, roughness, or a rough sensation, with diabetes, and the presence of cytologic atypia histologically showed a higher risk of malignant transformation (p < 0.05). In this study, the rate of malignant transformation in the treatment group (5/23) was lower than that in the untreated group (7/13), however, no statistically significant difference (p = 0.05). CONCLUSION The main complaints of pain, roughness, or foreign body sensation, coupled with cytologic atypia histologically are indicative of an increased risk of malignant transformation in PVL. Further research is needed to elucidate the influence of these clinicopathological parameters on the malignant progression of PVL.
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Affiliation(s)
- Chang Zhang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China
| | - Qingying Lan
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China
| | - Pan Wei
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China
| | - Yan Gao
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China
| | - Jianyun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China.
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China.
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, No. 22, Zhongguancun South Avenue, Haidian, Beijing, 100081, China.
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Kokubun K, Nakajima K, Akashi Y, Yamamoto K, Katakura A, Matsuzaka K. Clinicopathological evaluation of oral leukoplakia: a single-center study of 676 cases in Japan. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:529-536. [PMID: 38553305 DOI: 10.1016/j.oooo.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 06/19/2024]
Abstract
OBJECTIVES To analyze the clinical and histopathological characteristics of oral leukoplakia (OL) in the Japanese population and investigate the prevalence and risk factors for epithelial dysplasia (ED) and carcinoma within lesions. STUDY DESIGN Data, including age, sex, lesion site, and histopathological features, of 676 cases diagnosed with OL over the previous 10 years were analyzed. Dysplasia and carcinoma prevalence were determined. RESULTS In male patients, the most affected site was the gingiva (42.7%), whereas in females, it was the tongue (47.6%). Moreover, ED was more prevalent in males (41.9%), whereas epithelial hyperplasia was more common in females (44.7%). A significant difference was observed between affected sites with regard to the presence of dysplasia. The ED rates by site were 64.6% and 33.7% for the tongue and gingiva, respectively (P < 0.05). The squamous cell carcinoma rates by site were 23.4%, 5.4%, and 3.4% for the tongue, buccal mucosa, and gingiva, respectively (P < 0.05). Logistic regression analysis revealed a higher prevalence of dysplasia in males than it did in females and that the risk for both dysplasia and carcinoma was highest in the tongue. CONCLUSIONS Dysplasia is common in OL cases, often showing carcinoma. Early biopsy and interventions are key in OL management.
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Affiliation(s)
- Katsutoshi Kokubun
- Department of Pathology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan.
| | - Kei Nakajima
- Department of Pathology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Yoshihiko Akashi
- Department of Pathology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Kei Yamamoto
- Department of Pathology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Akira Katakura
- Department of Oral Pathobiological Science and Surgery, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
| | - Kenichi Matsuzaka
- Department of Pathology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
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18
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Cirillo N. Precursor Lesions, Overdiagnosis, and Oral Cancer: A Critical Review. Cancers (Basel) 2024; 16:1550. [PMID: 38672632 PMCID: PMC11048740 DOI: 10.3390/cancers16081550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/14/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Despite the profession placing great emphasis on oral potentially malignant disorders (OPMDs) as a gateway for early recognition and consequently better outcomes for oral cancer, the death rates for lip and oral cavity cancer have remained stagnant for three decades. Evidence shows that only a small fraction of oral cancers are in fact preceded by OPMDs, and that most OPMDs have an annual transformation rate of less than 1%. As OPMDs encompass a very heterogeneous group of oral conditions, it could be argued that only patients with oral mucosal diseases bearing a substantial risk of malignant transformation warrant close surveillance and treatment, these include proliferative leukoplakia, erythroplakia, non-homogeneous leukoplakia, as well as diseases presenting with severe dysplasia at biopsy. In this narrative review, I discuss the intricate epidemiology of the malignancies that we colloquially refer to as oral cancer, explore the limitations of focusing on OPMDs to reduce the incidence and mortality of oral cavity cancer, and argue that a may-be cancer label represents overdiagnosis for most OPMDs.
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Affiliation(s)
- Nicola Cirillo
- Melbourne Dental School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Carlton, VIC 3053, Australia;
- School of Dentistry, University of Jordan, Amman 11733, Jordan
- CoTreatAI, CoTreat Pty Ltd., Melbourne, VIC 3000, Australia
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19
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Peng J, Xu Z, Dan H, Li J, Wang J, Luo X, Xu H, Zeng X, Chen Q. Oral epithelial dysplasia detection and grading in oral leukoplakia using deep learning. BMC Oral Health 2024; 24:434. [PMID: 38594651 PMCID: PMC11005210 DOI: 10.1186/s12903-024-04191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND The grading of oral epithelial dysplasia is often time-consuming for oral pathologists and the results are poorly reproducible between observers. In this study, we aimed to establish an objective, accurate and useful detection and grading system for oral epithelial dysplasia in the whole-slides of oral leukoplakia. METHODS Four convolutional neural networks were compared using the image patches from 56 whole-slide of oral leukoplakia labeled by pathologists as the gold standard. Sequentially, feature detection models were trained, validated and tested with 1,000 image patches using the optimal network. Lastly, a comprehensive system named E-MOD-plus was established by combining feature detection models and a multiclass logistic model. RESULTS EfficientNet-B0 was selected as the optimal network to build feature detection models. In the internal dataset of whole-slide images, the prediction accuracy of E-MOD-plus was 81.3% (95% confidence interval: 71.4-90.5%) and the area under the receiver operating characteristic curve was 0.793 (95% confidence interval: 0.650 to 0.925); in the external dataset of 229 tissue microarray images, the prediction accuracy was 86.5% (95% confidence interval: 82.4-90.0%) and the area under the receiver operating characteristic curve was 0.669 (95% confidence interval: 0.496 to 0.843). CONCLUSIONS E-MOD-plus was objective and accurate in the detection of pathological features as well as the grading of oral epithelial dysplasia, and had potential to assist pathologists in clinical practice.
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Affiliation(s)
- Jiakuan Peng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
- Department of Stomatology, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ziang Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hongxia Dan
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jing Li
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jiongke Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Xiaobo Luo
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Hao Xu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Xin Zeng
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Research Unit of Oral Carcinogenesis and Management, Chinese Academy of Medical Sciences, West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China.
| | - Qianming Chen
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Affiliated Stomatology Hospital, Zhejiang University School of Stomatology, Hangzhou, Zhejiang, China
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Jing Y, Shu R, Wu T, Liu D, Luo X, Sun J, Chen F. Clinical efficacy of photodynamic therapy of oral potentially malignant disorder. Photodiagnosis Photodyn Ther 2024; 46:104026. [PMID: 38403144 DOI: 10.1016/j.pdpdt.2024.104026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 02/27/2024]
Abstract
OBJECTIVE To investigate the clinical efficacy of aminovalerate hydrochloride photodynamic therapy (PDT) for oral potentially malignant disorder (OPMD),oral leukoplakia (OLK), along with identifying the influencing factors.Additionally, the study aims to detect the rates of recurrence and malignancy after PDT. METHOD 60 patients with OPMD who received PDT at our hospital from 2006 to 2021 were included in this study. Relevant patient medical data were collected and analyzed using SAS 9.4 software.The Mann-Whitney U test was used to retrospectively analyze the factors influencing clinical efficacy, as well as recurrence rate and malignant transformation rate (MTR) after treatment. RESULT Among the 60 OPMD patients receiving PDT, complete remission in 13 (21.67 %), partial remission in 39 (65.00 %), and no remission in eight (13.33 %), resulting in an overall effective rate of 86.67 %.Fifteen patients experienced relapse, leading to a recurrence rate of 25.00 %. Among these relapses,11 patients occurred within one year after treatment, corresponding to an 18.33 % recurrence rate during that period. Moreover, nine patients developed malignant transformation (MT), resulting in an MTR of 15.00 %. Out of these patients, six individuals developed MT within one year after treatment, resulting in a one-year MTR of 10.00 %. CONCLUSION The study findings indicate that PDT shows promising clinical efficacy in the treatment of OPMD, with relatively limited and tolerable postoperative adverse reactions. However, there remains a certain rate of recurrence and malignancy after treatment. Therefore, close attention should be paid to postoperative monitoring, regular follow-up, and further expansion of the sample size to observe its long-term efficacy.
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Affiliation(s)
- Yin Jing
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China; Chongqing Municipal Key Laboratory of Oral Biomedical Engineering, Chongqing 401147, China
| | - Rong Shu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Tingting Wu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Dongqi Liu
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Xiao Luo
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Jun Sun
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China
| | - Fangchun Chen
- Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 401147, China; The Affiliated Hospital of Stomatology, Chongqing Medical University, Chongqing 401147, China.
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21
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Farah CS, Shearston K, Turner EC, Vacher M, Fox SA. Global gene expression profile of proliferative verrucous leukoplakia and its underlying biological disease mechanisms. Oral Oncol 2024; 151:106737. [PMID: 38408418 DOI: 10.1016/j.oraloncology.2024.106737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Proliferative verrucous leukoplakia (PVL) is a rare and enigmatic oral potentially malignant disorder which almost invariably results in oral squamous cell carcinoma (OSCC). The aims of this project were to use transcriptome profiling to characterise PVL gene expression patterns for biomarker identification and gain insight into the molecular aetiopathogenesis of PVL. METHODS Forty-three oral cavity mucosal biopsies from 32 patients with oral lesions clinically compatible with either PVL or non-PVL conventional oral leukoplakia (OLK) underwent transcriptome profiling by RNA sequencing. Data was analysed by hierarchical clustering, differential gene expression, functional enrichment and network analysis, sparse partial least squares discriminant analysis sPLS-DA, and immune cell phenotypic estimation. RESULTS We found 464 genes significantly differentially expressed at least 2-fold between PVL and non-PVL OLK (193 up and 271 down). HOX genes, including HOXA1 and HOXB7, keratin-associated proteins (KRTAPs) and olfactory receptor G proteins (OR) were significantly upregulated in PVL. Other upregulated genes in PVL included FOS, WNT16 and IFNA1. Pathway analysis showed that there was a significant downregulation of connective tissue signalling in PVL. Classifying multivariate models based upon 22 genes discriminated PVL from non-PVL OLK. Bioinformatic profiling showed that immune cell profiles in PVL and OLK were similar except that fibroblast markers were reduced in PVL. CONCLUSION These results demonstrate that PVL and conventional OLK are molecularly distinct with upregulation of many cancer-associated genes. They provide insight into the pathogenesis of PVL and show that biomarker based molecular diagnostics is feasible to discriminate and inform diagnosis and management.
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Affiliation(s)
- Camile S Farah
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia; Central Queensland University, Rockhampton, Queensland, Australia; Genomics for Life, Milton, QLD, Australia.
| | - Kate Shearston
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia; UWA Dental School, University of Western Australia, Nedlands, WA, Australia.
| | - Emma C Turner
- UWA Dental School, University of Western Australia, Nedlands, WA, Australia; Special Needs Dental Unit, Royal Darwin Hospital, Tiwi, NT, Australia
| | - Michael Vacher
- The Australian eHealth Research Centre, CSIRO Health and Biosecurity, Kensington, WA, Australia.
| | - Simon A Fox
- Australian Centre for Oral Oncology Research & Education, Nedlands, WA, Australia; UWA Dental School, University of Western Australia, Nedlands, WA, Australia.
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22
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Flores-Hidalgo A, Phero J, Steward-Tharp S, Williamson M, Paquette D, Krishnan D, Padilla R. Immunophenotypic and Gene Expression Analyses of the Inflammatory Microenvironment in High-Grade Oral Epithelial Dysplasia and Oral Lichen Planus. Head Neck Pathol 2024; 18:17. [PMID: 38456941 PMCID: PMC10923754 DOI: 10.1007/s12105-024-01624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Oral lichen planus (OLP) and oral epithelial dysplasia (OED) present diagnostic challenges due to clinical and histologic overlap. This study explores the immune microenvironment in OED, hypothesizing that immune signatures could aid in diagnostic differentiation and predict malignant transformation. METHODS Tissue samples from OED and OLP cases were analyzed using immunofluorescence/immunohistochemistry (IF/IHC) for CD4, CD8, CD163/STAT1, and PD-1/PDL-1 expression. RNA-sequencing was performed on the samples, and data was subjected to CIBERSORTx analysis for immune cell composition. Gene Ontology analysis on the immune differentially expressed genes was also conducted. RESULTS In OED, CD8 + T-cells infiltrated dysplastic epithelium, correlating with dysplasia severity. CD4 + lymphocytes increased in the basal layer. STAT1/CD163 + macrophages correlated with CD4 + intraepithelial distribution. PD-1/PDL-1 expression varied. IF/IHC analysis revealed differential immune cell composition between OED and OLP. RNA-sequencing identified upregulated genes associated with cytotoxic response and immunosurveillance in OED. Downregulated genes were linked to signaling, immune cell recruitment, and tumor suppression. CONCLUSIONS The immune microenvironment distinguishes OED and OLP, suggesting diagnostic potential. Upregulated genes indicate cytotoxic immune response in OED. Downregulation of TRADD, CX3CL1, and ILI24 implies dysregulation in TNFR1 signaling, immune recruitment, and tumor suppression. This study contributes to the foundation for understanding immune interactions in OED and OLP, offering insights into future objective diagnostic avenues.
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Affiliation(s)
- Andres Flores-Hidalgo
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - James Phero
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Scott Steward-Tharp
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, USA
| | - Megumi Williamson
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - David Paquette
- Department of Surgical Sciences, East Carolina University School of Dental Medicine, Greenville, USA
| | - Deepak Krishnan
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ricardo Padilla
- Department of Diagnostic Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, USA
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23
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Monteiro L, Mariano LC, Warnakulasuriya S. Podoplanin could be a predictive biomarker of the risk of patients with oral leukoplakia to develop oral cancer: A systematic review and meta-analysis. Oral Dis 2024; 30:207-215. [PMID: 36103586 DOI: 10.1111/odi.14378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Accepted: 08/27/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim of this study is to identify and analyze the existing literature on the utility of podoplanin to predict the risk of malignancy development (MD) in patients previously diagnosed with oral leukoplakia (OL). METHODS A systematic review and meta-analysis (SRMA) was performed though a search strategy using several electronic databases and a combination of keywords related to podoplanin and MD of OL, until 15 May, 2022 (PROSPERO CRD42022329326). Evaluation of the risk of bias (ROB) was performed using the Quality in Prognosis Studies Tool. The meta-analyses were estimated using fixed-effect models. RESULTS From 421 articles, 6 studies were finally included, that enrolled 546 patients with OL, of whom 125 presented with an oral cancer during follow-up (32 to 90 months). Some limitations regarding the ROB were identified mostly related to small sample sizes, short follow-up times, lack of information on covariables in the included studies and lack of accuracy (including sensitivity and specificity). Meta-analysis of 6 studies reveal that high expression of podoplanin carries a pooled hazard ratio (HR) of 3.72 (95% CI, 2.40-5.76; p < 0.00001) for MD without statistical heterogeneity (I2 = 0%, p = 0.53). CONCLUSION The results of this SRMA support the role of podoplanin immunohistochemical expression as a potential predictive biomarker to assess the risk of malignancy development in oral leukoplakia.
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Affiliation(s)
- Luis Monteiro
- Medicine and Oral Surgery Department, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
| | - Lorena C Mariano
- UNIPRO, Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), CESPU, Gandra, Portugal
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, and the WHO Collaborating Centre for Oral Cancer, London, UK
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24
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Adeoye J, Su YX. Leveraging artificial intelligence for perioperative cancer risk assessment of oral potentially malignant disorders. Int J Surg 2024; 110:1677-1686. [PMID: 38051932 PMCID: PMC10942172 DOI: 10.1097/js9.0000000000000979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
Oral potentially malignant disorders (OPMDs) are mucosal conditions with an inherent disposition to develop oral squamous cell carcinoma. Surgical management is the most preferred strategy to prevent malignant transformation in OPMDs, and surgical approaches to treatment include conventional scalpel excision, laser surgery, cryotherapy, and photodynamic therapy. However, in reality, since all patients with OPMDs will not develop oral squamous cell carcinoma in their lifetime, there is a need to stratify patients according to their risk of malignant transformation to streamline surgical intervention for patients with the highest risks. Artificial intelligence (AI) has the potential to integrate disparate factors influencing malignant transformation for robust, precise, and personalized cancer risk stratification of OPMD patients than current methods to determine the need for surgical resection, excision, or re-excision. Therefore, this article overviews existing AI models and tools, presents a clinical implementation pathway, and discusses necessary refinements to aid the clinical application of AI-based platforms for cancer risk stratification of OPMDs in surgical practice.
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Affiliation(s)
| | - Yu-Xiong Su
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, People’s Republic of China
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25
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Santana NCM, de Sena ACVP, Rocha PADS, de Arruda JAA, Torres-Pereira CC, Abreu LG, Fournier BPJ, Warnakulasuriya S, Silva TA. Oral cancer and oral potentially malignant disorders in patients with Fanconi anemia - A systematic review. Oral Oncol 2024; 150:106699. [PMID: 38309198 DOI: 10.1016/j.oraloncology.2024.106699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/10/2024] [Accepted: 01/18/2024] [Indexed: 02/05/2024]
Abstract
The purpose of the present study was to perform a systematic review focusing on oral squamous cell carcinoma (OSCC) and oral potentially malignant disorders (OPMD) in Fanconi anemia (FA) individuals. Electronic searches were undertaken in five databases supplemented by manual scrutiny and gray literature. Case reports and/or cases series were included. The searches yielded 55 studies describing 112 cases of OSCC (n = 107) and/or OPMD (n = 5) in FA individuals. The mean age at diagnosis of OSCC/OPMD was 27.1 (±9.6) years, and females (51.8 %) were slightly more affected. Ulcer (n = 37) or mass (n = 25) were described as clinical presentations for OSCC and OPMD. White lesions (n = 4) were the most common manifestation in OPMD. Tongue (47.2 %) was the most frequent location. Sixty-one (54.5 %) individuals underwent HSCT. Surgical resection (n = 75) was the main treatment adopted. The estimated rate of OPMD malignant transformation was 1.8 % and recurrences following OSCC excision occurred in 26.8 % of individuals. Overall, at 60 months of follow-up, the probability of survival fell to 25.5 % and at 64 months the probability of recurrence increased to 63.2 %. The present data support the need for strict surveillance of patients with FA, even in the absence of OPMD, for early OSCC detection and reduction of mortality.
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Affiliation(s)
- Nayara Conceição Marcos Santana
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | | | - Paula Alves da Silva Rocha
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - José Alcides Almeida de Arruda
- Department of Oral Diagnosis and Pathology, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Cassius Carvalho Torres-Pereira
- Department of Stomatology, School of Dentistry, Universidade Federal do Paraná, Curitiba, Paraná, Brazil; Multiprofessional Residency Program in Oncology and Hematology, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - Benjamin P J Fournier
- Department of Oral Biology, Université de Paris, Dental Faculty, France; Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Inserm, Laboratory of Molecular Oral Pathophysiology, France; AP-HP, Reference Center for Dental Rare Diseases, Rothschild Hospital (ORARES), Paris, France.
| | - Saman Warnakulasuriya
- Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, UK; WHO Collaborating Centre for Oral Cancer, London, UK.
| | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Oral Biology, Université de Paris, Dental Faculty, France; Centre de Recherche des Cordeliers, Université de Paris, Sorbonne Université, Inserm, Laboratory of Molecular Oral Pathophysiology, France.
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26
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González-Arriagada WA, Canedo-Marroquin G, Adorno-Farías D, Fernández-Ramires R. New insights into the role of the oral leukoplakia microenvironment in malignant transformation. FRONTIERS IN ORAL HEALTH 2024; 5:1363052. [PMID: 38450102 PMCID: PMC10914962 DOI: 10.3389/froh.2024.1363052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Oral leukoplakia is the most frequent and potentially malignant lesion of the oral cavity. Although dysplasia grading remains the main factor for risk assessment, challenges persist in determining the exact risk of transformation, and the literature has focused on studying alternative biomarkers. The interaction between dysplastic epithelial cells and the microenvironment starts early, and the communication is mainly mediated by lymphocytes, inflammatory factors, fibroblasts, and the extracellular matrix, leading to dysplastic progression. Leukoplakia-infiltrating leukocytes (LILs) and leukoplakia-associated fibroblasts (LAFs) play crucial roles in the dysplastic microenvironment. The immune response is related to intraepithelial T lymphocyte infiltration, mechanisms of immunosuppression coordinated by regulatory T cells, M2 macrophage polarization, and increased numbers of Langerhans cells; in contrast, fibroblastic and extracellular matrix factors are associated with increased numbers of pro-tumorigenic myofibroblasts, increased expression of metalloproteinases vs. decreased expression of TIMPs, and increased expression of chemokines and other inflammatory mediators. The microenvironment offers insights into the progression of leukoplakia to carcinoma, and understanding the complexity of the oral microenvironment in potentially malignant diseases aids in determining the risk of malignant transformation and proposing new therapeutic alternatives.
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Affiliation(s)
- Wilfredo Alejandro González-Arriagada
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
- IMPACT-Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Universidad de los Andes, Santiago, Chile
| | - Gisela Canedo-Marroquin
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
| | - Daniela Adorno-Farías
- School of Dentistry, Oral Medicine and Pathology Department, Universidad de Chile, Santiago, Chile
| | - Ricardo Fernández-Ramires
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
- Grupo Chileno de Cáncer Hereditario, Universidad de los Andes, Santiago, Chile
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Peng L, Sun E, Zhang J, Cai L, Zheng J, Zeng Y. The effect of c-Fos on the prognosis, proliferation, and invasion of oral squamous cell carcinoma. Oral Dis 2024. [PMID: 38326698 DOI: 10.1111/odi.14892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This study aimed to determine the role of c-Fos in growth and invasion of oral squamous cell carcinoma (OSCC). METHODS Immunohistochemistry was used to assess c-Fos expression in 94 OSCC tissues and 30 adjacent normal tissues, the correlation between c-Fos expression and clinicopathological characteristics was examined, and Kaplan-Meier and Cox analysis were used to investigate the role of c-Fos in predicting the prognosis of OSCC patients. The effects of c-Fos on the growth and invasion of OSCC were disclosed by overexpression and knockdown of c-Fos. Furthermore, based on bioinformatics prediction, the effect of miR-155-5p on c-Fos expression was examined, and dual-luciferase reporter assay system was used to determine whether miR-155-5p regulated the transcriptional activity of c-Fos in OSCC. RESULTS c-Fos was markedly increased in OSCC tissues and cells. c-Fos upregulation indicates a poor prognosis in OSCC patients, and c-Fos promotes cell proliferation, migration, and invasion in OSCC. miR-155-5p could regulate the expression and the transcriptional activity of c-Fos by directly targeting the c-Fos 3'-UTR. CONCLUSION This study demonstrated that c-Fos contributed to the progression of OSCC and may act as a potential target for OSCC therapy, and a potential prognostic biomarker of OSCC.
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Affiliation(s)
- Lu Peng
- Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China
| | - Ercan Sun
- Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China
- Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jinfang Zhang
- Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lanyu Cai
- Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China
| | - Jun Zheng
- Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China
| | - Yan Zeng
- Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, China
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Cai X, Zhang J, Li L, Liu L, Tang M, Zhou X, Peng C, Li X, Chen X, Xu M, Zhang H, Wang J, Huang Y, Li T. Copy Number Alterations Predict Development of OSCC from Oral Leukoplakia. J Dent Res 2024; 103:138-146. [PMID: 38217281 DOI: 10.1177/00220345231217160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024] Open
Abstract
Oral leukoplakia (OLK) is a common type of potentially malignant disorder. Early identification of the malignancy potential leads to a better management of OLK and prediction of development of oral squamous cell carcinoma (OSCC). However, there has been no effective biomarker to assess the risk of malignancy in OLK. Genomic copy number alteration (CNA) is a complex chromosomal structural variation in the genome and has been identified as a potential biomarker in multiple cancers. This study aimed to develop a predictive model for the malignant transformation risk of OLK by copy number analysis. A total of 431 OLK samples with long-term follow-up (median follow-up of 67 mo) from multiple academic centers were analyzed for CNAs. CNA events increased with the severity of hyperplasia, mild dysplasia, moderate dysplasia, and severe dysplasia. More CNA events were present in patients with OLK who later developed OSCC than in those with OLK who did not. By multivariate Cox regression analysis, the OLK of the CNA scorehigh group showed an increased risk of malignant transformation than the CNA scorelow group (P < 0.001). A CNA score model was developed to accurately predict the prognosis (area under the receiver operating characteristic curve [AUC] = 0.879; 95% confidence interval [CI], 0.799-0.959) and was validated using data from 2 external centers (AUC = 0.836, 95% CI, 0.683-0.989; AUC = 0.876, 95% CI, 0.682-1.000), and all of them showed better prediction performances than histopathological grade in assessing the transformation risk of OLK. Furthermore, we performed CNA models among 4 subgroups of OLK with hyperplasia, mild dysplasia, moderate dysplasia, and severe dysplasia and found that CNA score can accurately predict malignant transformation of different subgroups. CNA score may be a useful biomarker to predict malignant transformation of OLK. Subtyping of OLK by the CNA score could contribute to better management of OLK and predicting development of OSCC.
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Affiliation(s)
- X Cai
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - J Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - L Li
- Hunan Key Laboratory of Oral Health Research & Xiangya Stomatological Hospital & Xiangya School of Stomatology, Central South University, Changsha, Hunan, China
| | - L Liu
- Changping Laboratory, Beijing, China
| | - M Tang
- Beijing Advanced Innovation Center for Genomics (ICG), Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, China
| | - X Zhou
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - C Peng
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
| | - X Li
- Department of Periodontology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - X Chen
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - M Xu
- Hospital of Stomatology, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - H Zhang
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China
| | - J Wang
- School of Life Sciences, Tsinghua University, Beijing, China, Tsinghua University, Beijing, China
| | - Y Huang
- Beijing Advanced Innovation Center for Genomics (ICG), Biomedical Pioneering Innovation Center (BIOPIC), School of Life Sciences, Peking University, Beijing, China
- College of Chemistry and Molecular Engineering and Beijing National Laboratory for Molecular Sciences, Peking University, Beijing, China
| | - T Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
- Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences (2019RU034), Beijing, China
- Laboratory of Oral Biomedicine, Henan University School of Stomatology, Kaifeng, Henan, China
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I A, Raghavan Pillai VB, P Joseph A, Ramani P, P J, Ramalingam K. Identification and Evaluation of Cancer Stem Cells in Oral Squamous Cell Carcinoma and Oral Epithelial Dysplasia Using NANOG: An Immunohistochemical Study. Cureus 2024; 16:e55111. [PMID: 38558704 PMCID: PMC10979711 DOI: 10.7759/cureus.55111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Squamous cell carcinoma of the oral cavity may show precursor lesions, termed as potentially malignant disorders, of which leukoplakia is the most frequent one. Oral leukoplakia is a clinical diagnosis for which the histological diagnosis may be either hyperplasia or oral epithelial dysplasia (OED) and sometimes even oral squamous cell carcinoma (OSCC). Cancer stem cells (CSCs), identified in various tumors, are a specific group of cells that exhibit the properties of self-renewal and differentiation. Among the various biomarkers that identify CSCs, the transcription factor NANOG is considered to be a significant one. AIM In this study, we intend to identify and compare the immunohistochemical expression of NANOG in OSCC, OED, and normal oral mucosa. METHODOLOGY Tissue blocks of OSCC (n=28), OED (n=28), and normal oral mucosa (n=28) were used in this study. Specimens were immunohistochemically analyzed for NANOG expression. The results were statistically analyzed using one-way ANOVA, Games-Howell post hoc, and Student t-test. Statistical Product and Service Solutions (SPSS, version 21; IBM SPSS Statistics for Windows, Armonk, NY) software was used for performing the statistical analysis, and the level of significance was set as 0.05. OBSERVATIONS NANOG expression was higher in OSCC when compared to oral dysplasias and normal oral mucosa, in decreasing order. A significantly higher histo-score and labeling index score were observed in OSCC and oral dysplasias compared to normal oral mucosa (p=<0.001). CONCLUSION The expression levels of NANOG were positively correlated with disease progression in OSCC, implicating that NANOG can be used as a surrogate marker of oral oncogenesis and prognosis. Therefore, decoding the molecular mechanisms of NANOG regulation in the progression of cancer helps in developing new therapeutic strategies for oral cancer.
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Affiliation(s)
- Arya I
- Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Trivandrum, IND
| | - Varun B Raghavan Pillai
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
- Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Trivandrum, IND
| | - Anna P Joseph
- Oral and Maxillofacial Pathology, PMS College of Dental Science and Research, Trivandrum, IND
| | - Pratibha Ramani
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Jayanthi P
- Oral and Maxillofacial Pathology, Azeezia College of Dental Sciences and Research, Kollam, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Haj-Hosseini N, Lindblad J, Hasséus B, Kumar VV, Subramaniam N, Hirsch JM. Early Detection of Oral Potentially Malignant Disorders: A Review on Prospective Screening Methods with Regard to Global Challenges. J Maxillofac Oral Surg 2024; 23:23-32. [PMID: 38312957 PMCID: PMC10831018 DOI: 10.1007/s12663-022-01710-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 11/28/2022] Open
Abstract
Oral cancer is a cancer type that is widely prevalent in low-and middle-income countries with a high mortality rate, and poor quality of life for patients after treatment. Early treatment of cancer increases patient survival, improves quality of life and results in less morbidity and a better prognosis. To reach this goal, early detection of malignancies using technologies that can be used in remote and low resource areas is desirable. Such technologies should be affordable, accurate, and easy to use and interpret. This review surveys different technologies that have the potentials of implementation in primary health and general dental practice, considering global perspectives and with a focus on the population in India, where oral cancer is highly prevalent. The technologies reviewed include both sample-based methods, such as saliva and blood analysis and brush biopsy, and more direct screening of the oral cavity including fluorescence, Raman techniques, and optical coherence tomography. Digitalisation, followed by automated artificial intelligence based analysis, are key elements in facilitating wide access to these technologies, to non-specialist personnel and in rural areas, increasing quality and objectivity of the analysis while simultaneously reducing the labour and need for highly trained specialists.
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Affiliation(s)
- Neda Haj-Hosseini
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Centre for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
| | - Joakim Lindblad
- Centre for Image Analysis, Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, University of Gothenburg, The Sahlgrenska Academy, Gothenburg, Sweden
- Clinic of Oral Medicine, Public Dental Service, Gothenburg, Region Västra Götaland Sweden
| | - Vinay Vijaya Kumar
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, India
- Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
| | - Narayana Subramaniam
- Department of Head and Neck Oncology, Sri Shankara Cancer Hospital and Research Centre, Bangalore, India
| | - Jan-Michaél Hirsch
- Department of Surgical Sciences, Odontology and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
- Department of Research & Development, Public Dental Services Region Stockholm, Stockholm, Sweden
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González-Moles MÁ, Ramos-García P. An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis. Cancers (Basel) 2024; 16:608. [PMID: 38339358 PMCID: PMC10854587 DOI: 10.3390/cancers16030608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/22/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
A systematic review and a meta-analysis is presented on published articles on the malignant transformation of oral lichen planus (OLP) and related conditions, which, based on current evidence, updates an earlier systematic review published by our research group that included publications until November 2018. In this updated study (Nov-2023) we searched MEDLINE, Embase, Web of Science, and Scopus. We evaluated the methodological quality of studies (QUIPS tool) and carried out meta-analyses. The inclusion criteria were met by 101 studies (38,083 patients), of which, 20 new primary-level studies (11,512 patients) were published in the last 5 years and were added to our updated study. The pooled malignant transformation ratio was 1.43% (95% CI = 1.09-1.80) for OLP; 1.38% (95% CI = 0.16-3.38) for oral lichenoid lesions; 1.20% (95% CI = 0.00-4.25) for lichenoid reactions; and 5.13% (95% CI = 1.90-9.43) for OLP with dysplasia. No significant differences were found between the OLL or LR groups and the OLP subgroup (p = 0.853 and p = 0.328, respectively), and the malignant transformation was significantly higher for the OLP with dysplasia group in comparison with the OLP group (p = 0.001). The factors that had a significant impact with a higher risk of malignant transformation were the presence of epithelial dysplasia, a higher methodological quality, the consumption of tobacco and alcohol, the location of lesions on the tongue, the presence of atrophic and erosive lesions, and infection by the hepatitis C virus. In conclusion, OLP behaves as an oral potentially malignant disorder (OPMD), whose malignancy ratio is probably underestimated as a consequence essentially of the use of inadequate diagnostic criteria and the low methodological quality of the studies on the subject.
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Affiliation(s)
- Miguel Ángel González-Moles
- School of Dentistry, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Pablo Ramos-García
- School of Dentistry, University of Granada, 18071 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
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Rokhshad R, Mohammad-Rahimi H, Price JB, Shoorgashti R, Abbasiparashkouh Z, Esmaeili M, Sarfaraz B, Rokhshad A, Motamedian SR, Soltani P, Schwendicke F. Artificial intelligence for classification and detection of oral mucosa lesions on photographs: a systematic review and meta-analysis. Clin Oral Investig 2024; 28:88. [PMID: 38217733 DOI: 10.1007/s00784-023-05475-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVE This study aimed to review and synthesize studies using artificial intelligence (AI) for classifying, detecting, or segmenting oral mucosal lesions on photographs. MATERIALS AND METHOD Inclusion criteria were (1) studies employing AI to (2) classify, detect, or segment oral mucosa lesions, (3) on oral photographs of human subjects. Included studies were assessed for risk of bias using Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). A PubMed, Scopus, Embase, Web of Science, IEEE, arXiv, medRxiv, and grey literature (Google Scholar) search was conducted until June 2023, without language limitation. RESULTS After initial searching, 36 eligible studies (from 8734 identified records) were included. Based on QUADAS-2, only 7% of studies were at low risk of bias for all domains. Studies employed different AI models and reported a wide range of outcomes and metrics. The accuracy of AI for detecting oral mucosal lesions ranged from 74 to 100%, while that for clinicians un-aided by AI ranged from 61 to 98%. Pooled diagnostic odds ratio for studies which evaluated AI for diagnosing or discriminating potentially malignant lesions was 155 (95% confidence interval 23-1019), while that for cancerous lesions was 114 (59-221). CONCLUSIONS AI may assist in oral mucosa lesion screening while the expected accuracy gains or further health benefits remain unclear so far. CLINICAL RELEVANCE Artificial intelligence assists oral mucosa lesion screening and may foster more targeted testing and referral in the hands of non-specialist providers, for example. So far, it remains unclear if accuracy gains compared with specialized can be realized.
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Affiliation(s)
- Rata Rokhshad
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI On Health, Berlin, Germany
| | - Hossein Mohammad-Rahimi
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI On Health, Berlin, Germany
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, Postal Code: 1983963113, Iran
| | - Jeffery B Price
- Department of Oncology and Diagnostic Sciences, University of Maryland, School of Dentistry, Baltimore, Maryland 650 W Baltimore St, Baltimore, MD, 21201, USA
| | - Reyhaneh Shoorgashti
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, 9Th Neyestan, Pasdaran, Tehran, Iran
| | | | - Mahdieh Esmaeili
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, 9Th Neyestan, Pasdaran, Tehran, Iran
| | - Bita Sarfaraz
- School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, Postal Code: 1983963113, Iran
| | - Arad Rokhshad
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, 9Th Neyestan, Pasdaran, Tehran, Iran
| | - Saeed Reza Motamedian
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences & Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjoo Blvd, Evin, Shahid Chamran Highway, Tehran, Postal Code: 1983963113, Iran.
| | - Parisa Soltani
- Department of Oral and Maxillofacial Radiology, Dental Implants Research Center, Dental Research Institute, School of Dentistry, Isfahan University of Medical Sciences, Salamat Blv, Isfahan Dental School, Isfahan, Iran
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Nepales, Italy
| | - Falk Schwendicke
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI On Health, Berlin, Germany
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Charitépl. 1, 10117, Berlin, Germany
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Nautiyal M, Kumar Vadivel J, Ramalingam K. Prevalence of Keratosis in the Oral Cavity: A Clinical Retrospective Study. Cureus 2024; 16:e52199. [PMID: 38347988 PMCID: PMC10859883 DOI: 10.7759/cureus.52199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION A lesion in the oral cavity can appear clinically white due to an increase in keratin (hyperkeratosis), an increase in the thickness of the spongiotic cells (acanthosis), accumulation of fluid within the epithelium, and formation of the pseudomembrane. There are several innocuous white lesions, while only a few require aggressive management. The lesions of frictional keratosis, tobacco pouch keratosis, and morsicatio buccarum (MB) are innocuous white lesions that can be treated with simple treatments. This paper aimed to study the prevalence of the three white lesions among the patients visiting Saveetha Dental College. The objectives were to study the gender prevalence of the lesions and the average age distribution of these lesions. METHODOLOGY The study was a retrospective clinical study that collected data from DIAS (Digital Information and Archiving Software) over four years among the patients visiting Saveetha Dental College. The inclusion and exclusion criteria were based on the clinical diagnostic features, and the existence of any other oral potentially malignant disorder made the exclusion criteria. The collected data were entered into Statistical Package for the Social Sciences (SPSS) version 26.0 (IBM Corp., Armonk, NY). The data were analyzed for descriptive and inferential statistics. RESULTS The total number of patients with the lesions mentioned above was 5,613, with an average age of 37.28 years. The most common lesion was frictional keratosis with 4,026 patients, followed by tobacco pouch keratosis with 1,537 patients. The least common was MB, with 54 patients. Based on gender, all of the above lesions were most commonly seen in men. The age analysis revealed that frictional keratosis and MB were seen in middle age, while tobacco pouch keratosis was seen in middle to old age. DISCUSSION From the above study, it is noticed that frictional keratosis was the most common lesion, which had arisen most commonly in the third molar region and was seen in the younger age group due to the eruption of the third molars. Among the lesions, the only tobacco-induced lesion was tobacco pouch keratosis, which was seen predominantly in middle to old age, implying that prolonged habit usage was essential for the lesion to develop. CONCLUSION This study has helped us understand the prevalence of innocuous keratotic lesions in the South Indian population. The findings of this study will give a guideline for confirming the clinical diagnosis of similar lesions. This could potentially reduce the need for undertaking a biopsy and rather try treating with less invasive modalities, and when no response is seen, then it would be worthwhile to do a biopsy.
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Affiliation(s)
- Manya Nautiyal
- Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Jayanth Kumar Vadivel
- Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Yang J, Song Y, Xu S, Ge S, Haiwen Z. CircHLA-C: A significantly upregulated circRNA co-existing in oral leukoplakia and oral lichen planus. Organogenesis 2023; 19:2234504. [PMID: 37531467 PMCID: PMC10399473 DOI: 10.1080/15476278.2023.2234504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 06/02/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Oral leukoplakia (OLK) and oral lichen planus (OLP) are common precancerous lesions of the oral mucosa. The role of circular RNAs (circRNAs) in OLK and OLP is unclear. The aim of this study was to evaluate the circRNA expression profiles of OLK and OLP, and further explore the potential role of circRNAs in the pathogenesis of these two diseases. METHODS High throughput sequencing technology was performed to detect the differentially expressed circRNA in OLK (n = 6), OLP (n = 6), oral squamous cell carcinoma (n = 6), and normal oral mucosa tissues (n = 6). Expression of selected circRNAs was validated by qRT-PCR, enzyme tolerance assay, and Sanger sequencing. Expanded sample size validation was done in 20 tissue pairs. The biological processes and signal pathways involved in differential circRNA were analyzed by GO and KEGG enrichment. TargetScan and MiRanda were used to predict miRNAs downstream of circRNA and draw competitive endogenous RNA network diagram. RESULTS Forty-nine circRNAs were significantly altered in OLK and OLP, including 30 upregulated and 19 downregulated circRNAs. The five selected circRNAs were validated by qRT-PCR, Sanger sequencing, and RNase R assay. GO and KEGG analyses indicated that the upregulated circHLA-C may be involved in the biological process of immune function of OLK and OLP. Bioinformatics analysis indicated that circHLA-C may be involved in the progression of OLK and OLP as a ceRNA. In validation with expanded sample size, PCR results showed that circHLA-C expression was significantly upregulated in OLK and OLP. ROC analysis indicated that circHLA-C has potential diagnostic value with good accuracy and specificity. CONCLUSION Our study revealed that circHLA-C is the most significantly upregulated circRNA co-existing in OLK and OLP, and we preliminarily discuss the role of circHLA-C in the etiopathogenesis and progression of OLK and OLP.
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Affiliation(s)
- Jingwen Yang
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong UniversityNational Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Yuhan Song
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong UniversityNational Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Siming Xu
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong UniversityNational Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Shuyun Ge
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong UniversityNational Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Zhou Haiwen
- Department of Oral Mucosal Diseases, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- College of Stomatology, Shanghai Jiao Tong UniversityNational Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
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Rushiti A, Castellani C, Cerrato A, Fedrigo M, Sbricoli L, Bressan E, Angelini A, Bacci C. The Follow-Up Necessity in Human Papilloma Virus-Positive vs. Human Papilloma Virus-Negative Oral Mucosal Lesions: A Retrospective Study. J Clin Med 2023; 13:58. [PMID: 38202065 PMCID: PMC10779469 DOI: 10.3390/jcm13010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Human papilloma virus (HPV) is known as the main cause of cervical cancer. Data also indicate its role in head-neck cancer, especially oropharyngeal cancer. The correlation between high-risk HPV and oral cancer is still controversial. HPV-related lesions of the oral cavity are frequent and, in most cases, benign. The primary aim of this study was to establish if there is a different follow-up necessity between HPV-positive compared to HPV-negative oral lesions. The secondary aim was to evaluate the recurrence of HPV-related lesions. All patients who underwent a surgical procedure of oral biopsy between 2018 and 2022, with ulterior histopathological examination and HPV typing, were examined. A total of 230 patients were included: 75 received traumatic fibroma as diagnosis, 131 HPV-related lesions, 9 proliferative verrucous leukoplakia, and 15 leukoplakia. The frequency and period of follow-up varied in relation to HPV positivity and diagnosis. This study confirms what has already been reported by other authors regarding the absence of recommendations of follow-up necessity in patients with oral mucosal lesions. However, the data demonstrate that there was a statistically significant difference in the sample analyzed regarding the follow-up of HPV-positive vs. HPV-negative patients. It also confirms the low recurrence frequency of HPV-related oral lesions.
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Affiliation(s)
- Armina Rushiti
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
| | - Chiara Castellani
- Cardiovascular Pathology, University of Padova Medical School, University of Padova, 35122 Padova, Italy; (C.C.); (M.F.)
| | - Alessia Cerrato
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
| | - Marny Fedrigo
- Cardiovascular Pathology, University of Padova Medical School, University of Padova, 35122 Padova, Italy; (C.C.); (M.F.)
| | - Luca Sbricoli
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
| | - Eriberto Bressan
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
| | - Annalisa Angelini
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
| | - Christian Bacci
- Unit of Oral Pathology and Medicine and Odontostomatological Diagnostics, Section of Clinical Dentistry, Department of Neurosciences, University of Padova, 35122 Padova, Italy; (A.R.); (A.C.); (L.S.); (E.B.); (A.A.)
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Lan Q, Zhang C, Hua H, Hu X. Compositional and functional changes in the salivary microbiota related to oral leukoplakia and oral squamous cell carcinoma: a case control study. BMC Oral Health 2023; 23:1021. [PMID: 38115005 PMCID: PMC10731685 DOI: 10.1186/s12903-023-03760-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 12/12/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumours with increasing incidence, and oral leukoplakia (OLK) has a strong tendency to undergo malignant transformation. The oral microbiota may influence oral cancer progression, but the salivary bacterial composition and functional changes in OSCC and OLK have not been comprehensively elucidated. Therefore, we compared salivary bacteria in OLK and OSCC patients with healthy controls (HC). METHODS Metagenomic sequencing was used to compare the bacterial composition and functional changes of 18 OSCC patients, 21 OLK patients and 21 HC. Spearman correlation was used to identify possible associations between functions and bacteria. RESULTS Gemella was the most differentially enriched genus in OSCC. At the species level, Streptococcus sp. NPS 308, Streptococcus agalactiae, Gemella haemolysans and Gemella morbillorum were slightly increased in OLK and OSCC. Kyoto Encyclopedia of Genes and Genomes (KEGG) results showed that OSCC was mainly associated with metabolism functions, including lipid metabolism, carbohydrate metabolism and glycan biosynthesis and metabolism. The synthesis and degradation of ketone bodies, cysteine and methionine metabolism and glycerolipid metabolism differed significantly among the three groups, and were highest in OSCC and lowest in HC. And G. haemolysans was significantly associated with these selected metabolic pathways. CONCLUSIONS Metagenomic analysis revealed significant differences in the salivary microbiota among OSCC, OLK and HC. Thus, salivary microbiota composition and functional changes may be associated with OSCC progression. Metabolism of nonessential amino acids such as cysteine and methionine in bacteria may play an important role in oral oncogenesis, and more studies of the mechanism between metabolisms of bacteria and oral oncogenesis are needed in the future.
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Affiliation(s)
- Qingying Lan
- Department of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing, 100081, China
| | - Chang Zhang
- Department of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing, 100081, China
| | - Hong Hua
- Department of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing, 100081, China
| | - Xiaosheng Hu
- Department of Oral Medicine, National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Peking University School and Hospital of Stomatology, 22 South Zhongguancun Avenue, Haidian District, Beijing, 100081, China.
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Roy S, Girotra S, Radhakrishnan A, Basu S. Prevalence and determinants of tobacco consumption and oral cancer screening among men in India: evidence from a nationally representative cross-sectional Survey. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-023-02161-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/24/2023] [Indexed: 07/24/2024] Open
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Kitabatake K, Ishikawa S, Sugimoto M, Enomoto A, Kaneko M, Ota S, Edamatsu K, Yusa K, Hemmi T, Okuyama N, Iino M. Salivary metabolomics for oral leukoplakia with and without dysplasia. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101618. [PMID: 37659754 DOI: 10.1016/j.jormas.2023.101618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/04/2023]
Abstract
PURPOSE Oral leukoplakia (OL) is a common potentially malignant oral disorder. Therefore, there is a need for simple screening methods for OL before its transformation into oral cancer. Furthermore, because invasive open biopsy is the sole method to determine if an OL lesion is dysplastic, there is also a clinical need for non-invasive methods to differentiate dysplastic OL from non-dysplastic OL. This study aimed to identify salivary metabolites that can help differentiate patients with OL from healthy controls (HC) and also dysplastic OL from non-dysplastic OL. MATERIAL & METHODS Whole unstimulated saliva samples were collected from patients with OL (n = 30) and HCs (n = 29). The OL group included nine patients with dysplastic OL and 20 with non-dysplastic OL. Hydrophilic metabolites in the saliva samples were comprehensively analyzed through capillary electrophoresis mass spectrometry. To evaluate the discrimination ability of a combination of multiple markers, a multiple logistic regression (MLR) model was developed to differentiate patients with OL from HCs and dysplastic OL from non-dysplastic OL. RESULTS Twenty-eight metabolites were evidently different between patients with OL and HCs. Finally, three metabolites (guanine, carnitine, and N-acetylputrescine) were selected to develop the MLR model, which resulted in a high area under curve (AUC) of the receiver operating characteristic (ROC) to differentiate patients with OL from HCs (AUC = 0.946, p < 0.001, 95% confidential interval [CI] = 0.889- 1.000). Similarly, two metabolites were evidently different between patients with dysplastic and non-dysplastic OL. Finally, only one metabolite (7-methylguanine) was selected in the MLR model, which revealed a moderate discrimination ability for dysplastic and non-dysplastic OL (AUC = 0761, p = 0.027, 95% CI = 0.551-0.972). CONCLUSION Our candidate salivary metabolites showed potential not only to discriminate OL from HC, but also to discriminate dysplastic OL from non-dysplastic OL.
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Affiliation(s)
- Kenichiro Kitabatake
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Shigeo Ishikawa
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan.
| | - Masahiro Sugimoto
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Ayame Enomoto
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Miku Kaneko
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Sana Ota
- Institute for Advanced Biosciences, Keio University, Tsuruoka, Japan
| | - Kaoru Edamatsu
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Kazuyuki Yusa
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Tomoharu Hemmi
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Naoki Okuyama
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
| | - Mitsuyoshi Iino
- Department of Dentistry, Oral and Maxillofacial - Plastic and Reconstructive Surgery Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan
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S S, R S. Prevalence of Oral Submucous Fibrosis With Other Oral Potentially Malignant Disorders: A Clinical Retrospective Study. Cureus 2023; 15:e49642. [PMID: 38161840 PMCID: PMC10755630 DOI: 10.7759/cureus.49642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Background Oral submucous fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder that causes scarring of the oral cavity, pharynx, and upper oesophagus. It is most common in Southeast Asia, but it is also found in other parts of the world. Oral potentially malignant disorders (OPMDs) are a group of oral lesions that have an increased risk of developing into oral cancer. The study aimed to evaluate the prevalence of OSMF associated with other OPMDs. The presence of multiple OPMDs existing in one patient is a significant finding, as it is associated with an elevated risk of developing malignancy. The risk of malignant transformation increases with the number of OPMDs present in a patient; patients with two OPMDs have a three to four times higher risk of developing malignancy than those with a single OPMD. Patients with three or more OPMDs have a 7-10 times higher risk and the risk of malignant transformation depends on the type of OPMD. Materials and methods The study was conducted in the Department of Oral Medicine and Radiology, Saveetha Dental College and Hospitals, Chennai, India, to investigate the prevalence of OSMF with other OPMDs. The study team retrieved 630 case records of patients with OSMF from the electronic database between January 2018 and March 2023. All of the patients in the study had OSMF, as well as other OPMDs such as leukoplakia, candidiasis, actinic cheilitis, dyskeratosis congenita, erythroplakia, lichen planus, sideropenic dysphagia (Plummer-Vinson syndrome), and discoid lupus erythematosus. Both clinical and histopathological examinations confirmed these diagnoses. Oral mucosal lesions without coexisting OSMF were excluded. The study was done on the basis of age group, habits, type of habits, associated coexisting lesions, and systemic condition. Results The patients were clinically examined and diagnosed. Of the 630 cases, 10% had OSMF with OPMDs. The most common OPMDs associated with OSMF were leukoplakia (86%), followed by candidiasis (12%) and both leukoplakia and candidiasis (2%). Based on gender, the incidence of OSMF was higher in males compared to females with 67% and 33%, respectively. Conclusion OSMF is more likely to develop into malignancy; the widespread use of areca nut products in India has contributed to the rising incidence of OSMF. Accumulating epidemiological data can help to identify high-risk populations for prevention and control measures. Earlier oral cancer diagnosis and treatment can increase the likelihood of a favourable outcome.
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Affiliation(s)
- Sowmya S
- Department of Oral Medicine, Radiology, and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Sangavi R
- Department of Oral Medicine, Radiology, and Special Care Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
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40
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Hirsch JM, Sandy R, Hasséus B, Lindblad J. A paradigm shift in the prevention and diagnosis of oral squamous cell carcinoma. J Oral Pathol Med 2023; 52:826-833. [PMID: 37710407 DOI: 10.1111/jop.13484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/05/2023] [Accepted: 08/06/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Oral squamous cell carcinoma (OSCC) is a widespread disease with only 50%-60% 5-year survival. Individuals with potentially malignant precursor lesions are at high risk. METHODS Survival could be increased by effective, affordable, and simple screening methods, along with a shift from incisional tissue biopsies to non-invasive brush biopsies for cytology diagnosis, which are easy to perform in primary care. Along with the explainable, fast, and objective artificial intelligence characterisation of cells through deep learning, an easy-to-use, rapid, and cost-effective methodology for finding high-risk lesions is achievable. The collection of cytology samples offers the further opportunity of explorative genomic analysis. RESULTS Our prospective multicentre study of patients with leukoplakia yields a vast number of oral keratinocytes. In addition to cytopathological analysis, whole-slide imaging and the training of deep neural networks, samples are analysed according to a single-cell RNA sequencing protocol, enabling mapping of the entire keratinocyte transcriptome. Mapping the changes in the genetic profile, based on mRNA expression, facilitates the identification of biomarkers that predict cancer transformation. CONCLUSION This position paper highlights non-invasive methods for identifying patients with oral mucosal lesions at risk of malignant transformation. Reliable non-invasive methods for screening at-risk individuals bring the early diagnosis of OSCC within reach. The use of biomarkers to decide on a targeted therapy is most likely to improve the outcome. With the large-scale collection of samples following patients over time, combined with genomic analysis and modern machine-learning-based approaches for finding patterns in data, this path holds great promise.
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Affiliation(s)
- Jan-Michaél Hirsch
- Department of Surgical Sciences, Oral and Maxillofacial Surgery, Medical Faculty, Uppsala University, Uppsala, Sweden
- Department of Research, Development and Education, Public Dental Services, Stockholm, Sweden
| | - Ronak Sandy
- Eastmaninstitutet, Department of Oral and Maxillofacial Surgery, Public Dental Services, Folktandvården Stockholm, Stockholm, Sweden
| | - Bengt Hasséus
- Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joakim Lindblad
- Computerised Image Processing, Department of Information Technology, Centre for Image Analysis, Uppsala University, Uppsala, Sweden
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McCord C, Achita P, Kiss A, Magalhaes MA, Darling M, Bradley G. Progression to malignancy in oral potentially malignant disorders: a retrospective study of 5,036 patients in Ontario, Canada. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:466-477. [PMID: 37563059 DOI: 10.1016/j.oooo.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/27/2023] [Accepted: 06/07/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES Determine the rate of malignant transformation (MT) of oral potentially malignant disorders (OPMDs) and risk factors for transformation. STUDY DESIGN The OPMD database (2001-2015) from 2 biopsy services in Ontario, Canada, was linked to the Ontario Cancer Registry to determine the rate of progression to oral squamous cell carcinoma (OSCC). Clinical and histologic features of progressed and non-progressed cases were compared to determine risk factors for progression. RESULTS The MT rate was 6.4% (322/5,036 cases). The mean time for cancer development was 51.2 months. 33.6% of cases (107/322) progressed after over 60 months. The risk of cancer increased with age and was higher in non-smokers. The MT rate was highest in the tongue (11.4%), followed by the floor of mouth (7.1%) and gingiva (6.5%). Histologic grade was associated with progression to cancer (P < .0001). Atypical verrucous-papillary lesions with no or mild dysplasia predominantly affected older patients' gingiva, and the progression rate was significantly higher than conventional mild dysplasia (9.2% vs 3.2%, P = .0002). CONCLUSIONS Our population-based retrospective study showed that <10% of OPMDs progressed to cancer, which could take many years. Atypical papillary-verrucous proliferation without high-grade dysplasia is a subtype of OPMD requiring further study.
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Affiliation(s)
- Christina McCord
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Paulina Achita
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Marco A Magalhaes
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Darling
- Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Grace Bradley
- Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada; Department of Dental and Maxillofacial Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
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Brouns ER, Evren I, Wils LJ, Poell JB, Brakenhoff RH, Bloemena E, de Visscher JGAM. Oral leukoplakia classification and staging system with incorporation of differentiated dysplasia. Oral Dis 2023; 29:2667-2676. [PMID: 35765231 DOI: 10.1111/odi.14295] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 04/15/2022] [Accepted: 06/24/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A classification and staging system for oral leukoplakia (OL) was introduced to promote uniform reporting. In this system, size and the histopathologic diagnosis are assessed and combined in a staging system. The various stages could be predictive for malignant transformation of OL. Differentiated dysplasia (DD) was recently recognized as an important architectural pattern of dysplasia and is highly associated with malignant transformation (MT) of OL. In the present study, DD was incorporated in the OL-system. The aim of the present study was to test the adapted system on a cohort of patients with OL. PATIENT AND METHODS The group consisted of 140 patients. The size, absence or presence and degree of classic dysplasia (CD) and DD were incorporated into the OL-system. RESULTS In 31/140 patients, MT occurred. Size was not statistically significant with MT (p = 0.422). The presence of dysplasia was predictive for MT (p = 0.003), whereby severe CD and DD were highly statistically significant for MT (p = 0.008). Stage IV was statistically significant for MT (p = 0.011). CONCLUSIONS The present study emphasizes the value of the slightly modified OL-system with incorporation of DD in uniform reporting of OL and the value in predicting MT.
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Affiliation(s)
- Elisabeth R Brouns
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam UMC, Location VUmc and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ilkay Evren
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam UMC, Location VUmc and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Leon J Wils
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam UMC, Location VUmc and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jos B Poell
- Department of Otolaryngology / Head & Neck Surgery, Amsterdam UMC, Location VUmc and Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Department of Otolaryngology / Head & Neck Surgery, Amsterdam UMC, Location VUmc and Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam UMC, Location VUmc and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Department of Pathology, Amsterdam UMC, Location VUmc and Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jan G A M de Visscher
- Department of Oral and Maxillofacial Surgery / Oral Pathology, Amsterdam UMC, Location VUmc and Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Pentenero M, Castagnola P, Castillo FV, Isaevska E, Sutera S, Gandolfo S. Predictors of malignant transformation in oral leukoplakia and proliferative verrucous leukoplakia: An observational prospective study including the DNA ploidy status. Head Neck 2023; 45:2589-2604. [PMID: 37563936 DOI: 10.1002/hed.27483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/23/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND This prospective observational study investigated the determinants of malignant transformation (MT) in localized oral leukoplakia (OL) and proliferative verrucous leukoplakia (PVL). METHODS Demographic, clinical, histological, and DNA ploidy status data were collected at enrolment. Survival analysis was performed (MT being the event of interest). RESULTS One-hundred and thirty-three patients with OL and 20 patients with PVL entered the study over 6 years (mean follow-up 7.8 years). The presence of OED, DNA ploidy, clinical presentation, and lesion site were associated with MT in patients with OL in a univariate analysis. In a multivariate model, OED was the strongest predictor of MT in patients with OL. Adding DNA ploidy increased the model's predictive power. None of the assessed predictors was associated with MT in patients with PVL. CONCLUSIONS DNA ploidy might identify a subset OL with low risk or minimal risk of MT, but it does not seem to be a reliable predictor in patients with PVL.
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Affiliation(s)
- Monica Pentenero
- Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Turin, Italy
| | | | | | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Samuele Sutera
- Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Turin, Italy
| | - Sergio Gandolfo
- Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Turin, Italy
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Vilar-Villanueva M, Somoza-Martín JM, Blanco-Carrión A, García-García A, García-Carnicero T, Marichalar-Mendía X, Gallas-Torreira M, Gándara-Vila P. Importance of the vaporization margin during CO 2 laser treatment of oral leukoplakia: A survival study. Oral Dis 2023; 29:2689-2695. [PMID: 35942539 DOI: 10.1111/odi.14345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/16/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The main purpose of this study was to assess the response of oral leukoplakia to CO2 laser vaporization treatment, as well as determining possible factors that may affect recurrence of lesions. MATERIALS AND METHODS A retrospective study was conducted, in which the medical records of patients who had been clinically and histologically diagnosed with oral leukoplakia and treated with CO2 laser between 1996 and 2019 at the Oral Medicine Teaching Unit of the Faculty of Dentistry of the University of Santiago de Compostela were reviewed. RESULTS Fifty-eight patients were included: 36 female and 22 male subjects, with a mean age of 63.7 years old (SD ±13.1). The average follow-up time was 57.5 months (SD ±57.9). A relapse rate of 52.6% was determined. Of all the studied variables, the margin was the only one for which a statistically significant association with recurrence of lesions was demonstrated (p < 0.05). CONCLUSION The vaporization of lesions using CO2 laser with a safety margin of at least 3 mm from the clinical limits of OL is a key factor in preventing recurrence.
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Affiliation(s)
- Marta Vilar-Villanueva
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José Manuel Somoza-Martín
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrés Blanco-Carrión
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Abel García-García
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Tamara García-Carnicero
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Xabier Marichalar-Mendía
- Department of Nursing I, University of the Basque Country (UPV/EHU), Leioa, Bizkaia, Spain
- Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
- Osakidetza, Hospital Universitario Cruces, Barakaldo, Bizkaia, Spain
| | - Mercedes Gallas-Torreira
- School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pilar Gándara-Vila
- Oral Medicine, Oral Surgery and Implantology Unit, University of Santiago de Compostela, Santiago de Compostela, Spain
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Arroyo E, Pérez Sayáns M, Bravo SB, de Oliveira Barbeiro C, Paravani Palaçon M, Chamorro Petronacci CM, García Vence M, Chantada Vázquez MDP, Blanco Carrión A, Suárez Peñaranda JM, García García A, Gándara Vila P, Días Almeida J, Veríssimo da Costa GC, Sousa Nogueira FC, Medeiros Evaristo JA, de Abreu Pereira D, Rintala M, Salo T, Rautava J, Padín Iruegas E, Oliveira Alves MG, Morandin Ferrisse T, Albergoni da Silveira H, Esquiche León J, Vilela Silva E, Flores IL, Bufalino A. Identification of Proteomic Biomarkers in Proliferative Verrucous Leukoplakia through Liquid Chromatography With Tandem Mass Spectrometry. J Transl Med 2023; 103:100222. [PMID: 37507024 DOI: 10.1016/j.labinv.2023.100222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/13/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Proliferative verrucous leukoplakia (PVL) is an oral potentially malignant disorder associated with high risk of malignant transformation. Currently, there is no treatment available, and restrictive follow-up of patients is crucial for a better prognosis. Oral leukoplakia (OL) shares some clinical and microscopic features with PVL but exhibits different clinical manifestations and a lower rate of malignant transformation. This study aimed to investigate the proteomic profile of PVL in tissue and saliva samples to identify potential diagnostic biomarkers with therapeutic implications. Tissue and saliva samples obtained from patients with PVL were compared with those from patients with oral OL and controls. Label-free liquid chromatography with tandem mass spectrometry was employed, followed by qualitative and quantitative analyses, to identify differentially expressed proteins. Potential biomarkers were identified and further validated using immunohistochemistry. Staining intensity scan analyses were performed on tissue samples from patients with PVL, patients with OL, and controls from Brazil, Spain, and Finland. The study revealed differences in the immune system, cell cycle, DNA regulation, apoptosis pathways, and the whole proteome of PVL samples. In addition, liquid chromatography with tandem mass spectrometry analyses showed that calreticulin (CALR), receptor of activated protein C kinase 1 (RACK1), and 14-3-3 Tau-protein (YWHAQ) were highly expressed in PVL samples. Immunohistochemistry validation confirmed increased CARL expression in PVL compared with OL. Conversely, RACK1 and YWHA were highly expressed in oral potentially malignant disorder compared to the control group. Furthermore, significant differences in CALR and RACK1 expression were observed in the OL group when comparing samples with and without oral epithelial dysplasia, unlike the PVL. This research provides insights into the molecular mechanisms underlying these conditions and highlights potential targets for future diagnostic and therapeutic approaches.
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Affiliation(s)
- Esteban Arroyo
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Mario Pérez Sayáns
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Instituto de los materiales de Santiago de Compostela (iMATUS), Santiago, Spain; Instituto de Investigación Sanitaria de Santiago (IDIS) (ORALRES Group), Santiago de Compostela, Spain.
| | - Susana Belen Bravo
- Proteomic Unit, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | - Camila de Oliveira Barbeiro
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Mariana Paravani Palaçon
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | | | - María García Vence
- Proteomic Unit, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain
| | | | - Andrés Blanco Carrión
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Instituto de los materiales de Santiago de Compostela (iMATUS), Santiago, Spain
| | - José M Suárez Peñaranda
- Servicio de Anatomia Patológica, Hospital Clinico Universitario de Santiago, Choupana s/n Santiago de Compostela, Spain
| | - Abel García García
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Instituto de los materiales de Santiago de Compostela (iMATUS), Santiago, Spain
| | - Pilar Gándara Vila
- Oral Medicine, Oral Surgery and Implantology Unit (MedOralRes), Faculty of Medicine and Dentistry, University of Santiago de Compostela, Instituto de los materiales de Santiago de Compostela (iMATUS), Santiago, Spain; Instituto de Investigación Sanitaria de Santiago (IDIS) (ORALRES Group), Santiago de Compostela, Spain
| | - Janete Días Almeida
- Department of Bioscience and Buccal Diagnosis, São José dos Campos, Science and Technologies Institute, São Paulo State University (Unesp), São José dos Campos, São Paulo, Brazil
| | - Giovani Carlo Veríssimo da Costa
- Department of Basic Sciences, Nova Friburgo Health Institute, Univ. Federal Fluminense, Nova Friburgo, Rio de Janeiro, Brazil; Laboratory of Proteomics, Technological Development Support Laboratory (LADETEC), Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fábio César Sousa Nogueira
- Laboratory of Proteomics, Technological Development Support Laboratory (LADETEC), Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joseph Albert Medeiros Evaristo
- Laboratory of Proteomics, Technological Development Support Laboratory (LADETEC), Institute of Chemistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise de Abreu Pereira
- Program on Cellular and Molecular Oncobiology, Research Coordination, National Institute of Cancer (INCA), Rio de Janeiro, Brazil
| | - Mirjami Rintala
- Department of Oral Pathology, University of Turku, Turku, Finland
| | - Tuula Salo
- Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland; Department of Pathology, HUSLAB, Helsinki, Finland; Department of Cancer and Translational Research Unit, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu, Finland
| | - Jaana Rautava
- Department of Oral Pathology, University of Turku, Turku, Finland; Department of Oral and Maxillofacial Diseases, Clinicum, University of Helsinki, Helsinki, Finland; Department of Pathology, HUSLAB, Helsinki, Finland
| | - Elena Padín Iruegas
- Human Anatomy and Embryology Area, Faculty of Physiotherapy, Department of Functional Biology and Health Sciences, Pontevedra, Spain
| | | | - Túlio Morandin Ferrisse
- Department of Dental Materials and Prosthodontics, São Paulo State University (UNESP), School of Dentistry, Araraquara, Brazil
| | - Heitor Albergoni da Silveira
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Jorge Esquiche León
- Oral Pathology, Department of Stomatology, Public Oral Health, and Forensic Dentistry, Ribeirão Preto Dental School (FORP/USP), University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Evânio Vilela Silva
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
| | - Isadora Luana Flores
- Oral Pathology Area, Conservative Dentistry Department, Dental School, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre/RS, Brazil
| | - Andreia Bufalino
- Department of Diagnosis and Surgery, Araraquara, School of Dentistry, São Paulo State University (UNESP), Araraquara, São Paulo, Brazil
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Zhang C, Li B, Zeng X, Hu X, Hua H. The global prevalence of oral leukoplakia: a systematic review and meta-analysis from 1996 to 2022. BMC Oral Health 2023; 23:645. [PMID: 37670255 PMCID: PMC10481497 DOI: 10.1186/s12903-023-03342-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 08/22/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Oral leukoplakia(OLK) is a common oral potentially malignant disorder. The global prevalence of solely OLK was published in 2003, while the prevalence varied among different studies. In recent years, large-scale summary and definition-related analyses obtain insufficient attention. This study aimed to perform a systematic review of prevalence studies of oral leukoplakia and assess predisposing factors of its occurrence. METHODS The search terms ("Oral leukoplakia" OR OLK OR leukoplakia) AND (prevalence OR incidence OR epidemiology) were searched in databases (Pubmed, Embase, Scopus, and Web of Science) for OLK studies published from January 1996 until December 2022. The estimated prevalence calculation and risk of bias analysis used STATA 16.0. RESULTS We obtained 69 studies, including 1,263,028 participants, from 28 countries, and 6 continents. The prevalence was 1.39%, varying from 0.12 to 33.33%. The overall pooled estimated prevalence of OLK was 2.23% for population-based studies, 1.36% for clinic-based population studies, and 9.10% for specific populations. The pooled prevalence in different continents ranged from 0.33 to 11.74% with a statistical difference in the population-based calculation. The estimated prevalence of OLK was higher in males than in females. Those who smoked and consumed alcohol had a higher prevalence than those who did not. CONCLUSION Combining data from 69 published studies, the prevalence of OLK was determined as 1.39% and the pooling estimated global prevalence was 3.41%. The prevalence was relatively consistent and stable across different continents and different definitions. A higher pooled estimated prevalence was found among males, those aged over 60 years old, smokers, and alcohol consumers. The results from the included studies in this systematic review revealed that the prevalence was relatively consistent and stable across various definitions and continents, which may help in developing global treatment and prevention strategies for oral leukoplakia.
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Affiliation(s)
- Chang Zhang
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for DentalMaterials, Haidian District, No.22, Zhongguancun South Avenue, Beijing, 100081, People's Republic of China
| | - Bingjie Li
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for DentalMaterials, Haidian District, No.22, Zhongguancun South Avenue, Beijing, 100081, People's Republic of China
| | - Xiamei Zeng
- Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Stomatological Hospital of Xiamen Medical College, Xiamen, China
| | - XiaoSheng Hu
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for DentalMaterials, Haidian District, No.22, Zhongguancun South Avenue, Beijing, 100081, People's Republic of China.
| | - Hong Hua
- Department of Oral Medicine, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for DentalMaterials, Haidian District, No.22, Zhongguancun South Avenue, Beijing, 100081, People's Republic of China.
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47
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Guan JY, Luo YH, Lin YY, Wu ZY, Ye JY, Xie SM, Li J. Malignant transformation rate of oral leukoplakia in the past 20 years: A systematic review and meta-analysis. J Oral Pathol Med 2023; 52:691-700. [PMID: 37224426 DOI: 10.1111/jop.13440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND This meta-analysis aimed to assess the rate of malignant transformation (MT) of oral leukoplakia (OL) and to study potential risk factors for the MT of OL into oral squamous cell carcinoma (OSCC). METHOD We performed a bibliographic search on nine electronic databases, including PubMed, MEDLINE, and Wanfang Data, for data on the MT rate of OL. Possible risk factors were calculated using Comprehensive Meta-Analysis and Open Meta [Analyst] software. RESULTS The pooled proportion of OL MT for the total population described in the 26 selected studies was 7.20% (95% confidence interval: 5.40-9.10%). Nonhomogeneous type lesions, higher grades of dysplasia, the location of the lesion (tongue and multifocal), and female sex had significant effects on the MT of OL. CONCLUSION OL tended to develop into OSCC (7.2%), and those with significant MT risk factors should be subjected to regular follow-up and observation. However, we require large-scale prospective studies to validate these results, together with unified clinicopathological diagnostic criteria, standardized risk factor recording/assessment methods, and long-term follow-up guidelines.
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Affiliation(s)
- Jing-Yao Guan
- School of Stomatology, Jinan University, Guangzhou, China
| | - Yong-Hua Luo
- School of Stomatology, Jinan University, Guangzhou, China
| | - Ye-Yu Lin
- School of Stomatology, Jinan University, Guangzhou, China
| | - Zhou-Yang Wu
- School of Stomatology, Jinan University, Guangzhou, China
| | - Jing-Yi Ye
- School of Stomatology, Jinan University, Guangzhou, China
| | - Si-Ming Xie
- School of Stomatology, Jinan University, Guangzhou, China
| | - Jin Li
- Department of Stomatology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
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48
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Talwar V, Singh P, Mukhia N, Shetty A, Birur P, Desai KM, Sunkavalli C, Varma KS, Sethuraman R, Jawahar CV, Vinod PK. AI-Assisted Screening of Oral Potentially Malignant Disorders Using Smartphone-Based Photographic Images. Cancers (Basel) 2023; 15:4120. [PMID: 37627148 PMCID: PMC10452422 DOI: 10.3390/cancers15164120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
The prevalence of oral potentially malignant disorders (OPMDs) and oral cancer is surging in low- and middle-income countries. A lack of resources for population screening in remote locations delays the detection of these lesions in the early stages and contributes to higher mortality and a poor quality of life. Digital imaging and artificial intelligence (AI) are promising tools for cancer screening. This study aimed to evaluate the utility of AI-based techniques for detecting OPMDs in the Indian population using photographic images of oral cavities captured using a smartphone. A dataset comprising 1120 suspicious and 1058 non-suspicious oral cavity photographic images taken by trained front-line healthcare workers (FHWs) was used for evaluating the performance of different deep learning models based on convolution (DenseNets) and Transformer (Swin) architectures. The best-performing model was also tested on an additional independent test set comprising 440 photographic images taken by untrained FHWs (set I). DenseNet201 and Swin Transformer (base) models show high classification performance with an F1-score of 0.84 (CI 0.79-0.89) and 0.83 (CI 0.78-0.88) on the internal test set, respectively. However, the performance of models decreases on test set I, which has considerable variation in the image quality, with the best F1-score of 0.73 (CI 0.67-0.78) obtained using DenseNet201. The proposed AI model has the potential to identify suspicious and non-suspicious oral lesions using photographic images. This simplified image-based AI solution can assist in screening, early detection, and prompt referral for OPMDs.
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Affiliation(s)
- Vivek Talwar
- CVIT, International Institute of Information Technology, Hyderabad 500032, India; (V.T.); (C.V.J.)
| | - Pragya Singh
- INAI, International Institute of Information Technology, Hyderabad 500032, India; (P.S.); (K.S.V.)
| | - Nirza Mukhia
- Department of Oral Medicine and Radiology, KLE Society’s Institute of Dental Sciences, Bengaluru 560022, India; (N.M.); (P.B.)
| | | | - Praveen Birur
- Department of Oral Medicine and Radiology, KLE Society’s Institute of Dental Sciences, Bengaluru 560022, India; (N.M.); (P.B.)
| | - Karishma M. Desai
- iHUB-Data, International Institute of Information Technology, Hyderabad 500032, India;
| | | | - Konala S. Varma
- INAI, International Institute of Information Technology, Hyderabad 500032, India; (P.S.); (K.S.V.)
- Intel Technology India Private Limited, Bengaluru, India;
| | | | - C. V. Jawahar
- CVIT, International Institute of Information Technology, Hyderabad 500032, India; (V.T.); (C.V.J.)
| | - P. K. Vinod
- CCNSB, International Institute of Information Technology, Hyderabad 500032, India
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49
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Cai X, Li L, Yu F, Guo R, Zhou X, Zhang F, Zhang H, Zhang J, Li T. Development of a Pathomics-Based Model for the Prediction of Malignant Transformation in Oral Leukoplakia. J Transl Med 2023; 103:100173. [PMID: 37164265 DOI: 10.1016/j.labinv.2023.100173] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023] Open
Abstract
Accurate prognostic stratification of oral leukoplakia (OLK) with risk of malignant transformation into oral squamous cell carcinoma is crucial. We developed an objective and powerful pathomics-based model for the prediction of malignant transformation in OLK using hematoxylin and eosin (H&E)-stained images. In total, 759 H&E-stained images from multicenter cohorts were included. A training set (n = 489), validation set (n = 196), and testing set (n = 74) were used for model development. Four deep learning methods were used to train and validate the model constructed using H&E-stained images. Pathomics features generated through deep learning combined with machine learning algorithms were used to develop a pathomics-based model. Immunohistochemical staining of Ki67, p53, and PD-L1 was used to interpret the black box of the model. Pathomics-based models predicted the malignant transformation of OLK (validation set area under curve [AUC], 0.899; testing set AUC, 0.813) and significantly identified high-risk and low-risk populations. The prediction performance of malignant transformation from dysplasia grading (validation set AUC, 0.743) was lower than that of the pathomics-based model. The expressions of Ki67, p53, and PD-L1 were correlated with various pathomics features. The pathomics-based model accurately predicted the malignant transformation of OLK and may be useful for the objective and rapid assessment of the prognosis of patients with OLK.
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Affiliation(s)
- Xinjia Cai
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China; Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China
| | - Long Li
- Hunan Key Laboratory of Oral Health Research, Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Feiyan Yu
- Department of Oral Medicine, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Rongrong Guo
- Department of Oral Medicine, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China
| | - Xuan Zhou
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China
| | - Fang Zhang
- Department of Oral Medicine, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Shanxi Medical University School and Hospital of Stomatology, Taiyuan, China.
| | - Heyu Zhang
- Central Laboratory, Peking University School and Hospital of Stomatology, Beijing, China.
| | - Jianyun Zhang
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China; Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China.
| | - Tiejun Li
- Department of Oral Pathology, Peking University School and Hospital of Stomatology, National Center of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing, China; Research Unit of Precision Pathologic Diagnosis in Tumors of the Oral and Maxillofacial Regions, Chinese Academy of Medical Sciences, Beijing, China.
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50
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Alapati S, Fortuna G, Ramage G, Delaney C. Evaluation of Metabolomics as Diagnostic Targets in Oral Squamous Cell Carcinoma: A Systematic Review. Metabolites 2023; 13:890. [PMID: 37623834 PMCID: PMC10456490 DOI: 10.3390/metabo13080890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
In recent years, high-throughput technologies have facilitated the widespread use of metabolomics to identify biomarkers and targets for oral squamous cell carcinoma (OSCC). As a result, the primary goal of this systematic review is to identify and evaluate metabolite biomarkers and their pathways for OSCC that featured consistently across studies despite methodological variations. Six electronic databases (Medline, Cochrane, Web of Science, CINAHL, ProQuest, and Embase) were reviewed for the longitudinal studies involving OSCC patients and metabolic marker analysis (in accordance with PRISMA 2020). The studies included ranged from the inception of metabolomics in OSCC (i.e., 1 January 2007) to 30 April 2023. The included studies were then assessed for their quality using the modified version of NIH quality assessment tool and QUADOMICS. Thirteen studies were included after screening 2285 studies. The majority of the studies were from South Asian regions, and metabolites were most frequently derived from saliva. Amino acids accounted for more than quarter of the detected metabolites, with glutamate and methionine being the most prominent. The top dysregulated metabolites indicated dysregulation of six significantly enriched pathways including aminoacyl-tRNA biosynthesis, glutathione metabolism and arginine biosynthesis with the false discovery rate (FDR) <0.05. Finally, this review highlights the potential of metabolomics for early diagnosis and therapeutic targeting of OSCC. However, larger studies and standardized protocols are needed to validate these findings and make them a clinical reality.
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Affiliation(s)
- Susanth Alapati
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; (S.A.)
| | - Giulio Fortuna
- Department of Oral Medicine, Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK
| | - Gordon Ramage
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; (S.A.)
| | - Christopher Delaney
- Oral Sciences Research Group, Glasgow Dental School, School of Medicine, Dentistry and Nursing, University of Glasgow, 378 Sauchiehall Street, Glasgow G2 3JZ, UK; (S.A.)
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