Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway.
Department of Oral and Maxillofacial Surgery, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
J Dent Res. 2024 Oct;103(11):1066-1075. doi: 10.1177/00220345241266519. Epub 2024 Sep 18.
The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.
口腔白斑病（OL）的管理具有挑战性，因为其复发和恶性转化（MT）的风险较高，而复发性 OL 比非复发性 OL 具有更高的 MT 风险。本荟萃分析旨在研究 OL 复发与用于其治疗的手术技术以及其临床病理因素之间的关系。通过电子检索在 EMBASE、PubMed、Scopus 和 Web of Science 中检索报告手术后 OL 复发的研究。估计手术切除后 OL 复发的合并比例。根据手术技术、数据类型、上皮异型增生程度、解剖亚部位、病变的临床类型和大小、手术切缘和危险习惯进行亚组分析。进行元回归分析以确定年龄、性别和随访时间与 OL 复发之间的关系。还根据复发情况估计 MT 的风险。进行网络荟萃分析以确定与 OL 复发最少相关的手术方式。纳入了 80 项研究，共计 7614 例样本和各种手术方式（基于激光的技术、传统手术刀手术、冷冻疗法和光动力疗法）。观察到复发的合并比例为 22%。基于激光的手术导致 OL 复发较少，激光切除和汽化的联合被确定为最佳治疗方法。磨牙后区和多个部位的 OL、非均质 OL、年龄较大、女性、手术切缘不足、回顾性数据和咀嚼槟榔习惯与 OL 更高的复发率显著相关。复发性 OL 发生 MT 的风险比非复发性 OL 高 7.39 倍。这些结果表明，激光切除和汽化的联合可能会降低 OL 的复发率。此外，老年患者、女性和非均质 OL 的 OL 在任何手术后治疗后都需要密切监测。
