Department of Clinical & Diagnostic Sciences, Oral Medicine, King's College London Dental Institute and the WHO Collaborating Centre for Oral Cancer and Precancer, London, UK.
J Oral Pathol Med. 2011 Oct;40(9):677-83. doi: 10.1111/j.1600-0714.2011.01054.x. Epub 2011 Jul 18.
The aims of the study were to determine how frequently oral potentially malignant disorders (OPMDs) transform to cancer and to identify clinical and histological factors determining the rates of transformation.
The study included 1357 patients with biopsy-confirmed OPMDs seen at Guy's Hospital between 1990 and 1999 and followed up until 2005. The patients' details (name, date of birth, gender and any other relevant information) were matched to the Thames Cancer Registry (TCR) database and Office for National Statistics (ONS) to identify patients who subsequently developed oral cancer (ICD-10 C00-C06). From each patient's record, we identified their highest grade of dysplasia, graded as none, mild, moderate or severe. The outcome of principal interest was transformation to oral squamous cell carcinoma. To avoid co-existing malignancies, follow-up was started 6 months after the date of the index biopsy. Kaplan-Meier estimates and Cox proportional hazard analysis were undertaken to explore the factors associated with the time to transformation to oral cancer.
One thousand three hundred and fifty-seven patients were included in the study. The majority of patients were women (60.9%), and ∼30% were under 47 years of age. The most common OPMD was lichen planus/lichenoid reaction. Among all OPMDs, 204 (15.1%) had oral epithelial dysplasia (30 severe, 70 moderate and 104 mild). Thirty-five patients developed oral cancer over the follow-up period (2.6%). There was an association between dysplasia grade and time to transformation. Patients with severe dysplasia had a higher risk of transformation to oral cancer [HR 35.4 95% CI (14.2-88.3)] compared to those with no dysplasia. This association remained significant although attenuated [HR 21.6 95% CI (5.8-80.5)] following adjustment for sex, age, anatomical site of OPMD and diagnosis. A significant trend over dysplasia grades was evident (P < 0.0001). Transformation to oral cancer was also associated with increasing age (P = 0.0390).
In 2.6% of cases, OPMDs transformed to invasive cancer for a total person follow-up time of 12,273 years (mean 9.04 years). The severity of dysplasia is a significant predictor for malignant transformation.
本研究旨在确定口腔潜在恶性疾病（OPMD）转化为癌症的频率，并确定决定转化率的临床和组织学因素。
本研究纳入了 1990 年至 1999 年间在盖伊医院接受活检证实的 OPMD 患者 1357 例，并随访至 2005 年。通过患者的详细信息（姓名、出生日期、性别和任何其他相关信息）与泰晤士癌症登记处（TCR）数据库和国家统计局（ONS）进行匹配，以确定随后发生口腔癌（ICD-10 C00-C06）的患者。从每位患者的记录中，我们确定了他们的最高异型增生程度，分为无、轻度、中度或重度。主要关注的结局是转化为口腔鳞状细胞癌。为避免合并恶性肿瘤，随访从索引活检日期后 6 个月开始。采用 Kaplan-Meier 估计和 Cox 比例风险分析探讨与转化为口腔癌相关的因素。
本研究共纳入 1357 例患者。大多数患者为女性（60.9%），约 30%年龄在 47 岁以下。最常见的 OPMD 是扁平苔藓/苔藓样反应。在所有 OPMD 中，204 例（15.1%）存在口腔上皮异型增生（30 例重度、70 例中度和 104 例轻度）。在随访期间，35 例患者发生口腔癌（2.6%）。异型增生程度与转化时间之间存在关联。重度异型增生患者发生口腔癌的风险更高[HR 35.4，95%CI（14.2-88.3）]，与无异型增生患者相比。尽管调整了性别、年龄、OPMD 的解剖部位和诊断，这种关联仍然显著[HR 21.6，95%CI（5.8-80.5）]。在异型增生程度上存在显著的趋势（P<0.0001）。口腔癌的转化也与年龄的增加有关（P=0.0390）。
在总随访时间为 12273 年（平均 9.04 年）的情况下，OPMD 中有 2.6%转化为浸润性癌。异型增生的严重程度是恶性转化的显著预测因子。
