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What is the malignant transformation potential of oral lichen planus?

Evidence-Based Dentistry volume 23, pages 36–37 (2022)Cite this article

Abstract

Data sources In this systematic review and meta-analysis, Medline, Scopus and Web of Science databases were searched using Medical Subject Headings (MeSH) to identify studies assessing the risk of malignant transformation in oral lichen planus (OLP).

Study selection Observational studies published in English between 2003-2020 were independently assessed for inclusion by two blinded investigators.

Data extraction and synthesis Data were extracted independently by two investigators followed by discussion to reach consensus. This included: study design and patient characteristics; length of follow-up; risk of bias; method of OLP diagnosis; oral squamous cell carcinoma (OSCC) risk factors; rate of malignant transformation; and individual characteristics of malignant transformation cases. Cases of malignant transformation in the included studies were only included in meta-analysis if: 1) OLP diagnosis met current diagnostic criteria; 2) OSCC developed in the same site as previously diagnosed OLP after at least six months' follow-up; 3) the patient had no history of systemic immunosuppressive therapy, head and neck malignancy, or organ transplantation. Risk of bias was assessed using the modified Newcastle-Ottawa scale, and meta-analysis was conducted to estimate overall risk of OLP malignant transformation using the DerSimonian and Laird method. Pooled univariate odds ratios (OR) for malignant transformation were calculated based on gender, smoking status, alcohol consumption, hepatitis C infection and OLP subtype.

Results In total, 593 studies were identified after removal of duplicates and 33 studies were included for data extraction. The included sample comprised 12,838 patients with OLP, and 151 malignant transformation cases were reported in the included studies. The authors excluded 56 malignant transformation cases from the meta-analysis, most commonly because of the absence of pathological OLP diagnosis. Among included malignant transformation cases, the mean (SD) age was 58.1 (12.4) years, and 64% of the sample was female. Random-effects meta-analysis estimated an OLP malignant transformation rate of 0.2% (95%CI: 0.1-0.3%). Heterogeneity was low (I2 = 28.74%, p = 0.065). Malignant transformation was significantly higher among smokers (OR = 4.62, p = 0.001), alcohol consumers (OR = 3.22, p = 0.05), those with hepatitis C (OR = 3.77, p = 0.03) and atrophic or erosive OLP subtypes (OR = 2.70, p = 0.03). Gender was not associated with increased risk of malignant transformation.

Conclusions The malignant transformation rate of OLP is likely to be lower than previously reported, possibly as a result of variable diagnostic criteria. Whilst encouraging, clinical vigilance remains necessary, as OLP does carry a small risk of malignant transformation. Smoking, alcohol use, hepatitis C infection and erosive or atrophic subtypes appear to have a greater rate of malignant transformation.

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References

  1. Krutchkoff D J, Cutler L, Laskowski S. Oral lichen planus: the evidence regarding potential malignant transformation. J Oral Pathol 1978; 7: 1-7.

  2. Cheng Y-S L, Gould A, Kurago Z, Fantasia J, Muller S. Diagnosis of oral lichen planus: a position paper of the American Academy of Oral and Maxillofacial Pathology. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122: 332-354.

  3. van der Meij E H, van der Waal I. Lack of clinicopathologic correlation in the diagnosis of oral lichen planus based on the presently available diagnostic criteria and suggestions for modifications. J Oral Pathol Med 2003; 32: 507-512.

  4. van der Meij E H, Schepman K P, Smeele L E, van der Wal J E, Bezemer P D, van der Waal I. A review of the recent literature regarding malignant transformation of oral lichen planus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999; 88: 307-310.

  5. de Freitas Silva B S, Batista D C R, de Souza Roriz C F et al. Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis. Clin Oral Investig 2021; 25: 4329-4340.

  6. Lubin J H, Purdue M, Kelsey K et al. Total exposure and exposure rate effects for alcohol and smoking and risk of head and neck cancer: a pooled analysis of case-control studies. Am J Epidemiol 2009; 170: 937-947.

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Authors and Affiliations

  1. School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Elizabeth Offen & James R. Allison

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  1. Elizabeth Offen
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  2. James R. Allison
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Offen, E., Allison, J. What is the malignant transformation potential of oral lichen planus?. Evid Based Dent 23, 36–37 (2022). https://doi.org/10.1038/s41432-022-0240-4

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