Fitzpatrick Sarah G, Hirsch Stanley A, Gordon Sara C
Dr. Fitzpatrick is an adjunct assistant professor of oral and maxillofacial pathology, Department of Oral and Maxillofacial Medicine and Diagnostic Sciences, School of Dental Medicine, Case Western Reserve University, 10900 Euclid Ave., Cleveland, Ohio 44106,
J Am Dent Assoc. 2014 Jan;145(1):45-56. doi: 10.14219/jada.2013.10.
Determining the potential for malignant transformation of oral lichen planus (OLP) is complicated by difficulties in diagnosis, differentiation from oral lichenoid lesions (OLLs) and the phenomenon of premalignant lesions' exhibiting lichenoid characteristics. The authors of this systematic review evaluated evidence regarding malignant transformation of OLP and characterized transformation prevalence, clinical characteristics of OLP lesions developing into squamous cell carcinoma (SCC) and time to transformation.
The authors searched PubMed, Embase and Thomson Reuters Web of Science in a systematic approach. They evaluated observational English-language studies involving human participants published in peer-reviewed journals. Inclusion required patients to have the diagnosis of OLP or OLL as confirmed with biopsy results on initial enrollment. They excluded all patients who had dysplasia on initial biopsy of OLP or OLL lesions.
Sixteen studies were eligible. Among 7,806 patients with OLP, 85 developed SCC. Among 125 patients with OLL, four developed SCC. The rate of transformation in individual studies ranged from 0 to 3.5 percent. The overall rate of transformation was 1.09 percent for OLP; in the solitary study in which investigators evaluated OLL, the rate of transformation was 3.2 percent. Patients' average age at onset of SCC was 60.8 years. The authors noted a slight predominance of female patients among those who experienced malignant transformation. The most common subsite of malignant transformation was the tongue. The average time from diagnosis of OLP or OLL to transformation was 51.4 months.
A small subset of patients with a diagnosis of OLP eventually developed SCC. The most common demographic characteristics of patients in this subset were similar to the most common demographic characteristics associated with OLP in general (that is, being female, being older and being affected in areas common to this condition). It is prudent for clinicians to pursue continued regular observation and follow-up in patients with these conditions, even in patients who do not fit a traditional high-risk category for oral SCC.
口腔扁平苔藓（OLP）恶变潜能的判定较为复杂，这是由于诊断存在困难、与口腔苔藓样病变（OLL）难以鉴别，以及癌前病变呈现苔藓样特征的现象。本系统评价的作者评估了有关OLP恶变的证据，并对恶变发生率、发展为鳞状细胞癌（SCC）的OLP病变的临床特征以及恶变时间进行了特征描述。
作者采用系统的方法检索了PubMed、Embase和汤森路透科学网。他们评估了发表在同行评审期刊上的涉及人类受试者的观察性英文研究。纳入标准要求患者在初次入组时经活检结果确诊为OLP或OLL。他们排除了所有在OLP或OLL病变初次活检时存在发育异常的患者。
16项研究符合要求。在7806例OLP患者中，85例发展为SCC。在125例OLL患者中，4例发展为SCC。各研究中的恶变率在0%至3.5%之间。OLP的总体恶变率为1.09%；在研究者评估OLL的唯一一项研究中，恶变率为3.2%。发生SCC的患者发病时的平均年龄为60.8岁。作者指出，恶变患者中女性略占多数。最常见的恶变部位是舌。从诊断OLP或OLL到恶变的平均时间为51.4个月。
一小部分诊断为OLP的患者最终发展为SCC。该亚组患者最常见的人口统计学特征与一般OLP相关的最常见人口统计学特征相似（即女性、年龄较大且病变发生在该病常见部位）。临床医生对患有这些疾病的患者进行持续定期观察和随访是谨慎的做法，即使是那些不符合传统口腔SCC高风险类别的患者。
