A systematic review and a meta-analysis is presented on published articles on the malignant transformation of oral lichen planus (OLP) and related conditions, which, based on current evidence, updates an earlier systematic review published by our research group that included publications until November 2018. In this updated study (Nov-2023) we searched MEDLINE, Embase, Web of Science, and Scopus. We evaluated the methodological quality of studies (QUIPS tool) and carried out meta-analyses. The inclusion criteria were met by 101 studies (38,083 patients), of which, 20 new primary-level studies (11,512 patients) were published in the last 5 years and were added to our updated study. The pooled malignant transformation ratio was 1.43% (95% CI = 1.09–1.80) for OLP; 1.38% (95% CI = 0.16–3.38) for oral lichenoid lesions; 1.20% (95% CI = 0.00–4.25) for lichenoid reactions; and 5.13% (95% CI = 1.90–9.43) for OLP with dysplasia. No significant differences were found between the OLL or LR groups and the OLP subgroup (p= 0.853 andp= 0.328, respectively), and the malignant transformation was significantly higher for the OLP with dysplasia group in comparison with the OLP group (p= 0.001). The factors that had a significant impact with a higher risk of malignant transformation were the presence of epithelial dysplasia, a higher methodological quality, the consumption of tobacco and alcohol, the location of lesions on the tongue, the presence of atrophic and erosive lesions, and infection by the hepatitis C virus. In conclusion, OLP behaves as an oral potentially malignant disorder (OPMD), whose malignancy ratio is probably underestimated as a consequence essentially of the use of inadequate diagnostic criteria and the low methodological quality of the studies on the subject.
本文对口腔扁平苔藓（OLP）及相关病变恶性转化的已发表文献进行了系统综述与荟萃分析。基于当前证据，本研究更新了我们课题组先前发表的系统性综述（该综述收录了截至2018年11月的文献）。在此次更新研究（2023年11月）中，我们检索了MEDLINE、Embase、Web of Science和Scopus数据库，采用QUIPS工具评估研究方法学质量，并进行了荟萃分析。共纳入101项研究（38,083例患者），其中近5年发表的20项新原始研究（11,512例患者）被补充至本次更新分析中。 汇总分析显示：OLP的恶性转化率为1.43%（95% CI = 1.09–1.80）；口腔苔藓样病变为1.38%（95% CI = 0.16–3.38）；苔藓样反应为1.20%（95% CI = 0.00–4.25）；伴上皮异常增生的OLP为5.13%（95% CI = 1.90–9.43）。口腔苔藓样病变组或苔藓样反应组与OLP亚组间未发现显著差异（p值分别为0.853和0.328），而伴上皮异常增生的OLP组恶性转化率显著高于OLP组（p=0.001）。 对恶性转化风险具有显著影响的因素包括：上皮异常增生的存在、较高的研究方法学质量、烟草与酒精摄入、舌部病损、萎缩糜烂性病损以及丙型肝炎病毒感染。结论表明，OLP应被视为口腔潜在恶性疾患（OPMD），其恶性转化率可能因诊断标准使用不当及相关研究方法学质量较低而被低估。
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