Objectives: This study aimed to evaluate the malignant transformation (MT) risk profile in patients with oral proliferative leukoplakia (OPL) referred to the Oral Medicine and Oral Surgery units of Umberto I Hospital, Sapienza University of Rome.Methods: The departmental database and medical records of OPL patients were reviewed from January 2014 to June 2024. Demographic, clinical, and histopathological features and treatment strategies were collected in a de-identified dataset.Results: A total of 51 OPL patients (33 females and 18 males; mean age 62.86 ± 13.55 years) were included. MT occurred in 17.6% (n= 9) after a mean follow-up of 4.78 ± 2.59 years. A higher percentage of the presence of a previous history of solid or hematological tumor was observed in patients with MT, with an OR of 2.940 (95% CI 0.064–1.350), without statistical significance. The homogeneous clinical form was more common in patients without MT (78.57%), and the speckled clinical form was more common in patients with MT (44.44%). The percentage of patients with lesions located on the floor of the mouth, ventral surface of the tongue, and dorsal surface of the tongue was higher in patients with MT. The tongue was the most common site of MT, followed by the gingiva, buccal mucosa, and palate. At the histological level, a verrucous, nodular, or bulky architecture was more commonly observed in patients with MT, and the presence of band-like lymphocytic infiltrate was observed in all patients with MT. Higher dysplasia grades were significantly associated with MT (p= 0.009). No significant association was found between the treatment modality and MT risk, although laser ablation was associated with a trend toward lower risk.Conclusions: This study further suggests that the clinical morphology, lesion site, and histological grading may be important predicting factors for MT in OPL. The presence of a non-homogeneous lesion form, a higher grade of dysplasia, and a history of previous solid or hematological tumor led to a more aggressive disease course. Individualized risk assessment and long-term surveillance may be advisable.
目的：本研究旨在评估罗马萨皮恩扎大学翁贝托一世医院口腔内科与口腔外科收治的口腔增生性白斑（OPL）患者的恶性转化（MT）风险特征。 方法：回顾了2014年1月至2024年6月期间OPL患者的科室数据库和医疗记录。在一个去识别化的数据集中收集了人口统计学、临床、组织病理学特征以及治疗策略。 结果：共纳入51例OPL患者（女性33例，男性18例；平均年龄62.86 ± 13.55岁）。经过平均4.78 ± 2.59年的随访，MT发生率为17.6%（n=9）。在发生MT的患者中，观察到有既往实体瘤或血液肿瘤病史的比例更高，OR值为2.940（95% CI 0.064–1.350），但无统计学意义。均质型临床形态在未发生MT的患者中更常见（78.57%），而斑点型临床形态在发生MT的患者中更常见（44.44%）。病变位于口底、舌腹面和舌背面的患者在MT患者中所占比例更高。舌部是MT最常见的部位，其次是牙龈、颊黏膜和腭部。在组织学层面，疣状、结节状或团块状结构在MT患者中更常见，并且所有MT患者均观察到带状淋巴细胞浸润。更高级别的上皮异常增生与MT显著相关（p=0.009）。治疗方式与MT风险之间未发现显著关联，尽管激光消融显示出风险降低的趋势。 结论：本研究进一步提示，临床形态、病变部位和组织学分级可能是OPL发生MT的重要预测因素。非均质型病变形态、更高级别的上皮异常增生以及既往实体瘤或血液肿瘤病史导致了更具侵袭性的病程。建议进行个体化风险评估和长期监测。
肿瘤(癌症)患者之家