Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

Justin Kierce; Yuliang Shi; Hagen Klieb; Nick Blanas; Wei Xu; Marco Magalhaes

doi:10.1002/hed.26851

Identification of specific clinical risk factors associated with the malignant transformation of oral epithelial dysplasia

Head Neck. 2021 Nov;43(11):3552-3561. doi: 10.1002/hed.26851. Epub 2021 Sep 1.

Authors

Justin Kierce¹, Yuliang Shi^{2

3}, Hagen Klieb⁴, Nick Blanas^{4

5}, Wei Xu^{2

6}, Marco Magalhaes^{4

7}

Affiliations

¹ Oral & Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada.
² Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
³ Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.
⁴ Sunnybrook Health Sciences Centre, Department of Dental and Maxillofacial Sciences, Toronto, Ontario, Canada.
⁵ Oral & Maxillofacial Surgery, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
⁶ Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
⁷ Oral Pathology and Oral Medicine, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.

PMID: 34472151
DOI: 10.1002/hed.26851

Abstract

Background: Factors that increase the risk of malignant transformation of oral epithelial dysplasia (OED) are not completely elucidated.

Methods: A retrospective chart review was performed assessing risk factors for transformation of OED, and cancer staging for transformed cases at Sunnybrook Health Sciences Centre.

Results: Two-hundred four patients were diagnosed with OED, and 16.7% (34) underwent malignant transformation. Risk factors associated with transformation included: heavy tobacco smoking, excessive EtOH consumption, non-homogenous leukoplakia, size >200 mm² , moderate dysplasia or greater than moderate, progression of dysplasia grades, and immunosuppression. Transformed cases followed for a dysplastic lesion were associated with a stage-I cancer diagnosis, and cancer cases with no prior biopsy were associated with a stage-IV diagnosis.

Conclusions: In addition to commonly cited risk factors, immunosuppression was associated with malignant transformation, including the use of topical steroids. Analyzing risk factors can help clinicians define risk of progression in patients with OED.

Keywords: dysplasia; malignant transformation; oral cancer; pre-cancer; progression; risk factors.

MeSH terms

Humans
Leukoplakia, Oral
Mouth Neoplasms* / etiology
Precancerous Conditions*
Retrospective Studies
Risk Factors