Maxillofacial Surgery, Graduate School, Tokyo Medical and Dental University, Yushima 1-chome, 5-45, Bunkyo-Ku, Tokyo 113-8549, Japan.
Int J Clin Oncol. 2011 Feb;16(1):5-14. doi: 10.1007/s10147-010-0157-3. Epub 2011 Jan 12.
In this review article, the clinical and histopathological characteristics of oral premalignant lesions, and primarily oral leukoplakia, are noted and the risk factors for malignant transformation of oral leukoplakia are discussed. Malignant transformation rates of oral leukoplakia range from 0.13 to 17.5%. The risk factors of malignant transformation in the buccal mucosa and labial commissure are male gender with chewing tobacco or smoking in some countries such as India, or older age and/or being a non-smoking female in other countries. Some authors have reported that leukoplakia on the tongue or the floor of the mouth showed a high risk of malignant transformation, although others have found no oral subsites at high risk. In concurrence with some authors, the authors of this review view epithelial dysplasia as an important risk factor in malignant transformation; however, there are conflicting reports in the literature. Many authors believe that nonhomogeneous leukoplakia is a high risk factor without exception, although different terms have been used to describe those conditions. The large size of lesions and widespread leukoplakia are also reported risk factors. According to some studies, surgical treatment decreased the rate of malignant transformation; however, many review articles state that no definitive treatment including surgery can decrease the malignant transformation rate of oral leukoplakia because of the lack of randomized control trials of treatment. Tobacco chewing and smoking may be causative agents for cancerization of oral leukoplakia in some groups, and evidence for a role of human papilloma virus in the malignant transformation of oral leukoplakia is inconsistent. Further research to clarify its role in malignant transformation is warranted.
在这篇综述文章中，我们注意到了口腔癌前病变，尤其是口腔白斑病的临床和组织病理学特征，并讨论了口腔白斑病恶性转化的危险因素。口腔白斑病的恶性转化率范围为 0.13%至 17.5%。在印度等国家，颊黏膜和唇系带恶性转化的危险因素是男性、咀嚼烟草或吸烟，而在其他国家，如女性年龄较大且/或不吸烟则是危险因素。一些作者报告称，舌部或口底的白斑病恶性转化风险较高，尽管其他作者发现没有高风险的口腔部位。与一些作者的观点一致，本文作者认为上皮异型增生是恶性转化的重要危险因素；然而，文献中存在相互矛盾的报道。许多作者认为非均质型白斑病无一例外地是一个高风险因素，尽管文献中使用了不同的术语来描述这些情况。病变的大尺寸和广泛的白斑病也被报道为危险因素。一些研究表明，手术治疗降低了恶性转化的发生率；然而，许多综述文章指出，由于缺乏手术治疗的随机对照试验，包括手术在内的任何明确治疗都不能降低口腔白斑病的恶性转化率。在某些人群中，咀嚼烟草和吸烟可能是口腔白斑病癌变的原因，而人乳头瘤病毒在口腔白斑病恶性转化中的作用证据并不一致。需要进一步的研究来阐明其在恶性转化中的作用。
