Hankinson Paul, Clark Mollie, Walsh Hannah, Khurram Syed Ali
Unit of Oral and Maxillofacial Pathology, School of Clinical Dentistry, Faculty of Health, University of Sheffield, Sheffield, UK.
Histopathology. 2025 May;86(6):933-941. doi: 10.1111/his.15400. Epub 2024 Dec 17.
Oral epithelial dysplasia (OED) carries a risk of malignant transformation to oral squamous cell carcinoma. Clinical risk stratification for these patients is challenging, and reliant upon histological grading. The World Health Organisation (WHO) grading system is the current gold standard, although the binary system, two- and six-point prognostic models have also been proposed. This study assesses the interobserver agreement and malignant transformation outcomes for these four grading systems.
Up to 5 years of outcome data were collected for this retrospective cohort of 137 patients. Archived slides were reviewed by three pathologists, and grades for the WHO, binary, two- and six-point systems were assigned. Interobserver agreement was assessed with Light's kappa coefficient. Kaplan-Meier and Cox regression survival analyses were used to assess the correlation of each grading system with malignant transformation. The WHO, binary, two- and six-point systems had kappa coefficients of 0.42, 0.31, 0.17 and 0.41, respectively. All grading systems stratified lesions by malignant transformation risk, except the two-point model. Moderate OED (WHO) did not show an increased risk of malignant transformation, while severe OED had a hazard ratio (HR) of 13.7 (P = 0.02). The high-risk category for the binary and six-point systems had HRs of 4.67 (P = 0.03) and 5.28 (P = 0.03), respectively.
The interobserver agreement of the WHO, binary and six-point systems is comparable. The six-point and binary systems provided the most useful risk stratification. This study highlights the potential value of the six-point prognostic model for OED grading, which has comparable performance with the current gold standard.
口腔上皮发育异常（OED）有恶变为口腔鳞状细胞癌的风险。对这些患者进行临床风险分层具有挑战性，且依赖于组织学分级。世界卫生组织（WHO）分级系统是当前的金标准，尽管也有人提出了二元系统、两点和六点预后模型。本研究评估了这四种分级系统的观察者间一致性和恶变结果。
对这一包含137例患者的回顾性队列收集了长达5年的结局数据。三位病理学家对存档切片进行了复查，并给出了WHO、二元、两点和六点系统的分级。用莱特卡帕系数评估观察者间一致性。采用Kaplan-Meier法和Cox回归生存分析来评估每种分级系统与恶变的相关性。WHO、二元、两点和六点系统的卡帕系数分别为0.42、0.31、0.17和0.41。除两点模型外，所有分级系统均根据恶变风险对病变进行了分层。中度OED（WHO）未显示恶变风险增加，而重度OED的风险比（HR）为13.7（P = 0.02）。二元和六点系统的高风险类别HR分别为4.67（P = 0.03）和5.28（P = 0.03）。
WHO、二元和六点系统的观察者间一致性相当。六点和二元系统提供了最有用的风险分层。本研究强调了六点预后模型在OED分级中的潜在价值，其性能与当前金标准相当。
