Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients.
Malignant transformation of oral leukoplakia: a retrospective cohort study of 218 Chinese patients.
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DOI：
10.1186/1471-2407-10-685
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发表时间：
2010-12-16
期刊：
影响因子：
3.8
通讯作者：
Tang GY
中科院分区：
文献类型：
--
作者：
Liu W;Wang YF;Zhou HW;Shi P;Zhou ZT;Tang GY
口腔白斑病（OL）是最有名的潜在恶性疾病。WHO提出了一种新的异型增生分级二元系统，但其在预测恶变风险方面的生物学意义尚不清楚。本研究的目的是评估长期随访队列中的恶变率，探索新的异型增生分级二元系统的有用性，并确定中国OL恶变的重要危险因素。回顾性分析了218例临床和病理诊断为OL的患者。它们是从上海交通大学医学院第九人民医院口腔粘膜病科的所有存档文件中选出的。平均随访时间为5.3年。在218例病例中，39例（17.9%）OL患者发生口腔癌，平均病程为5.2年。考克斯回归分析显示，不典型增生是OL恶变的独立危险因素，而年龄、性别、病变部位、饮食习惯、吸烟和酒精摄入不是OL恶变的危险因素。与低危异型增生相比，高危异型增生OL的恶变风险增加4.57倍（95%可信区间，2.36-8.84; P < 0.001）。与此结果一致，Kaplan-Meier分析显示，高危异型增生OL的恶性发生率显著高于低危异型增生，尤其是在随访的前2-3年（对数秩检验，P < 0.001）。本研究旨在探讨新的二元系统在预测OL恶变风险中的作用。建议将高危异型增生作为评价OL患者恶变风险的重要指标，以指导临床治疗方案的选择。
Oral leukoplakia (OL) is the best-known potentially malignant disorder. A new binary system to grade dysplasia was proposed by WHO, but the biological significance in predicting malignant transformation risk is unknown. The objective of this study is to estimate the rate of malignant transformation in a long-term follow-up cohort, explore the usefulness of the new binary system of grading dysplasia and identify significant risk factors of OL malignant transformation in China. A total of 218 patients with clinical and histopathologic diagnosis of OL were retrospectively reviewed. They were selected among all archived files at the Department of Oral Mucosal Diseases, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. The mean follow-up period was 5.3 years. Among 218 cases, 39 (17.9%) OL patients developed oral cancer, with a mean duration of 5.2 years. Cox regression analysis revealed that dysplasia was an independent risk factor for OL malignant transformation, but age, gender, lesion site, diet habit, smoking and ethanol intake were not risk factors. High-risk dysplastic OL was associated with a 4.57-fold (95% confidence interval, 2.36-8.84; P < 0.001) increased risk of malignant transformation, compared with low-risk dysplasia. Consistent with this result, high-risk dysplastic OL had signicantly higher malignant incidence than low-risk dysplasia, particularly during the first 2-3 years of follow-up, by Kaplan-Meier analysis (Log-rank test, P < 0.001). The new binary system's function in predicting OL malignant transformation risk was investigated in this survey. The utilization of high-risk dysplasia as a significant indicator for evaluating malignant transformation risk in patients with OL was suggested, which may be helpful to guide treatment selection in clinical practice.