Scholarlink

Background <p>Oral epithelial dysplasia (OED) is a recognised precursor of oral squamous cell carcinoma (OSCC). Previous studies have identified specific OED features that are significantly associated with recurrence and malignant transformation (MT) in oral leukoplakia (OL). However, these findings lack validation and have not been comprehensively evaluated in well-designed prospective cohorts.</p> Methods <p>In this prospective study of 449 human papillomavirus-negative OPMD patients (median follow-up: 41.2&#xa0;months), clinico-demographic, histopathological, and systemic inflammatory parameters were analysed to identify predictors of persistence, recurrence, and MT. Hematoxylin and eosin-stained slides were independently reviewed by two pathologists, with discrepancies resolved by consensus. Associations were assessed using chi-square tests, ordinal logistic regression, Kaplan–Meier survival analysis and Cox proportional hazards regression. Variable importance was determined using mean decrease in Gini (MDG) scores derived from a random forest (RF) algorithm. Model performance was evaluated using the area under the receiver operating characteristic (AUROC) curve.</p> Results <p>Increasing age and lesion site were significantly associated with adverse outcomes (recurrence and/or MT). Tobacco exposure quantified as cigarette pack-years (<i>p</i> = 0.012) and bidi pack-years (<i>p</i> &lt; 0.001), as well as combined tobacco chewing, smoking and alcohol consumption (<i>p</i> = 0.025), were significantly associated with clinical risk. A lower platelet-to-lymphocyte ratio was also significantly associated with adverse outcomes (<i>p</i> = 0.031). Histopathologically, OED grade (<i>p</i> = 0.004) and increasing severity (mild, moderate and severe) were associated with shorter time to MT (<i>p</i> &lt; 0.001). RF analysis identified irregular epithelial stratification (MDG = 52.2) and enlarged nucleoli (MDG = 38.6) as the strongest predictors of MT. The OED-only model achieved an AUROC of 0.75 (sensitivity 72.7%, specificity 63.4%), improving to 0.77 (sensitivity 90.9%, specificity 55.3%) after inclusion of age and smoking variables.</p> Conclusion <p>This study underscores the importance of OED features in combination with clinical and inflammatory parameters. Validation in multi-centric cohorts with higher recurrence and MT rates is warranted to confirm their clinical utility.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Integrated Clinical, Histopathological, and Inflammatory Parameters for Predicting Malignant Transformation in High-Risk Oral Potentially Malignant Disorders: A Prospective Study

  • 期刊论文

  • 发表日期：

    2026年3月17日

查看全文
  • Rinal Chavda,
  • Swapnil U. Rane,
  • Neha Mittal,
  • Jitendra Gawde,
  • Drishti Rai,
  • Kiran Mahajan,
  • Mahima Sharma,
  • Sharmila Pimple,
  • Manoj B. Mahimkar

摘要

Background

Oral epithelial dysplasia (OED) is a recognised precursor of oral squamous cell carcinoma (OSCC). Previous studies have identified specific OED features that are significantly associated with recurrence and malignant transformation (MT) in oral leukoplakia (OL). However, these findings lack validation and have not been comprehensively evaluated in well-designed prospective cohorts.

Methods

In this prospective study of 449 human papillomavirus-negative OPMD patients (median follow-up: 41.2 months), clinico-demographic, histopathological, and systemic inflammatory parameters were analysed to identify predictors of persistence, recurrence, and MT. Hematoxylin and eosin-stained slides were independently reviewed by two pathologists, with discrepancies resolved by consensus. Associations were assessed using chi-square tests, ordinal logistic regression, Kaplan–Meier survival analysis and Cox proportional hazards regression. Variable importance was determined using mean decrease in Gini (MDG) scores derived from a random forest (RF) algorithm. Model performance was evaluated using the area under the receiver operating characteristic (AUROC) curve.

Results

Increasing age and lesion site were significantly associated with adverse outcomes (recurrence and/or MT). Tobacco exposure quantified as cigarette pack-years (p = 0.012) and bidi pack-years (p < 0.001), as well as combined tobacco chewing, smoking and alcohol consumption (p = 0.025), were significantly associated with clinical risk. A lower platelet-to-lymphocyte ratio was also significantly associated with adverse outcomes (p = 0.031). Histopathologically, OED grade (p = 0.004) and increasing severity (mild, moderate and severe) were associated with shorter time to MT (p < 0.001). RF analysis identified irregular epithelial stratification (MDG = 52.2) and enlarged nucleoli (MDG = 38.6) as the strongest predictors of MT. The OED-only model achieved an AUROC of 0.75 (sensitivity 72.7%, specificity 63.4%), improving to 0.77 (sensitivity 90.9%, specificity 55.3%) after inclusion of age and smoking variables.

Conclusion

This study underscores the importance of OED features in combination with clinical and inflammatory parameters. Validation in multi-centric cohorts with higher recurrence and MT rates is warranted to confirm their clinical utility.