Malignant Transformation in Leukoplakia and its Associated Factors in Southern Iran: A Hospital Based Experience
Abstract
Background: We evaluated factors that affect malignant transformation of leukoplakia in a sample of the Iranian population.
Methods: The records of patients with a clinical diagnosis of leukoplakia during a 20-year period from 1989-2009 referred to two of the largest referral centers in southern Iran were studied. Patients that developed malignant transformation were compared with patients that did not have malignant changes.
Results: Of 522 patients, female patients, those over 50 yr old and with lesions located on the tongue had the highest rate of malignant changes. Female patients with malignant changes were mostly non-smokers (76.4%), while male patients with malignant changes were mostly smokers (63.8% in non-smokers) (P<0.001). In our univariate analysis, male sex and smoking showed lower chances for malignant transformation (OR: 0.57; CI=0.397-0.822 and OR: 0.025; CI=0.141-0.299, respectively), while age above 50 was a risk factor for malignant transformation (OR: 3.57; CI=2.32-5.42). In the multivariate analysis, smoking (OR: 0.317; 95% CI=0.16–0.626) and morphological presentation as erythroplakia (OR: 0.025; 95% CI=0.005-0.131) had low chances for developing malignant changes, while site of lesion on the tongue (OR: 774; 95% CI=60-9838) and morphological presentation as erythroleukoplakia (OR: 6.26; 95% CI=3.16-12.38) were a risk factor for developing malignant changes
Conclusion: A follow-up program and further work-up should be considered for Iranian patients who have a leukoplakia lesion that is flat and are white patch or plaques with red components, in addition for patients who have lesions located on the tongue and for nonsmokers who develops leukoplakia lesions.
Chi AC, Damm DD, Neville BW, et al (2008). Oral and maxillofacial pathology. ed. Elsevier Health Sciences.
Lončar Brzak B, Mravak-Stipetić M, Canjuga I, et al (2012). The frequency and malignant transformation rate of oral lichen planus and leukoplakia–a retrospective study. Coll Antropol, 36:773-7.
George A, Sreenivasan B, Sunil S, et al (2011). Potentially Malignant Disorders Of Oral Cavity. J Oral Maxillofac Pathol, 2:95-100.
Masthan KM, Babu NA, Sankari SL, Priyadharsini C (2015). Leukoplakia: A short review on malignant potential. J Pharm Bioallied Sci, 7:S165-6.
Lee JJ, Hung HC, Cheng SJ, et al (2006). Carcinoma and dysplasia in oral leukoplakias in Taiwan: prevalence and risk factors. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 101:472-80.
Bremmer JF, Brakenhoff RH, Broeckaert MA, et al (2011). Prognostic value of DNA ploidy status in patients with oral leukoplakia. Oral Oncol, 47:956-60.
Brouns ER, Bloemena E, Belien JA, et al (2012). DNA ploidy measurement in oral leukoplakia: different results between flow and image cytometry. Oral Oncol, 48:636-40.
Feller L, Lemmer J (2012). Oral Leukoplakia as It Relates to HPV Infection: A Review. Int J Dent, 2012:540561.
Silverman jr S (2003). Leukoplakia and erythroplasia. Oral cancer. American Cancer Society: 29-47.
Mishra M, Mohanty J, Sengupta S, Tripathy S (2005). Epidemiological and clinicopathological study of oral leukoplakia. Indian J Dermatol Venereol Leprol, 71:161-5.
Brouns E, Baart J, Karagozoglu K, et al (2014). Malignant transformation of oral leukoplakia in a well-defined cohort of 144 patients. Oral Dis, 20:e19-24.
Holmstrup P, Vedtofte P, Reibel J, Stoltze K (2006). Long-term treatment outcome of oral premalignant lesions. Oral Oncol, 42:461-74.
Napier SS, Speight PM (2008). Natural history of potentially malignant oral lesions and conditions: an overview of the literature. J Oral Pathol Med, 37:1-10.
Sarraf-Zadegan N, Boshtam M, Shahrokhi S, et al (2004). Tobacco use among Iranian men, women and adolescents. Eur J Public Health, 14:76-8.
Amagasa T, Yamashiro M, Ishikawa H (2006). Oral leukoplakia related to malignant transformation. Oral Sci Int, 3:45-55.
Bagan JV, Jimenez-Soriano Y, Diaz-Fernandez JM, et al (2011). Malignant transformation of proliferative verrucous leukoplakia to oral squamous cell carcinoma: a series of 55 cases. Oral Oncol, 47:732-5.
Liu W, Shen XM, Liu Y, et al (2011). Malignant transformation of oral verrucous leukoplakia: a clinicopathologic study of 53 cases. J Oral Pathol Med, 40:312-6.
Kirita T, Horiuchi K, Tsuyuki M, et al (1995). Clinico-pathological study on oral leukoplakia: evaluation of potential for malignant transformation. Jpn J Oral Maxillofac Surg, 41:26-35.
Schepman K, Van der Meij E, Smeele L, Van der Waal I (1998). Malignant transformation of oral leukoplakia: a follow-up study of a hospital-based population of 166 patients with oral leukoplakia from The Netherlands. Oral Oncol, 34:270-5.
Pindborg J, Reibel J, Roed-Petersen B, Mehta F (1980). Tobacco-induced changes in oral leukoplakic epithelium. Cancer, 45:2330-6.
Gupta P, Mehta FS, Daftary D, et al (1980). Incidence rates of oral cancer and natural history of oral precancerous lesions in a 10-year follow-up study of Indian villagers. Community Dent Oral Epidemiol, 8:283-333.
Schepman K, Bezemer P, Van Der Meij E, et al(2001). Tobacco usage in relation to the anatomical site of oral leukoplakia. Oral Dis, 7:25-7.
Sudbø J, Kildal W, Risberg B, et al (2001). DNA content as a prognostic marker in patients with oral leukoplakia. N Engl J Med, 344:1270-8.
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Issue | Vol 46 No 8 (2017) | |
Section | Original Article(s) | |
Keywords | ||
Oral lesion Leukoplakia Malignant transformation Iran |
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