Development and validation of nomogram for prediction of malignant transformation in oral leukoplakia: A large‐scale cohort study

Abstract

Purpose Oral leukoplakia (OL) is the well‐known disorder of oral mucosa, which has potential to be malignant and can lead to squamous cell carcinoma (OSCC). In the following study, we developed a comprehensive nomogram for predicting the malignant progression of OL, based on analysis of clinicopathological variables. Methods A retrospective analysis of patients diagnosed with OL was performed between 1998 and 2017 at the Peking University School and Hospital of Stomatology. OL was confirmed by pre‐treatment biopsy. The candidate risk factors for OL malignant transformation were screened from clinicopathological variables using the Cox proportional hazard regression analysis. The nomogram model was generated based on the COX regression results and was validated through Harrell concordance index (c‐index) and calibration plots Results The incidence of OL malignant transformation (MT) was 12.2% (107/875), and the mean follow‐up time was 4.5 years. The risk factors (age, histologic grade, site of lesion and smoking habit) derived from Cox proportional hazard regression analysis were incorporated in a novel nomogram model for prediction of MT severity. The c‐index value of the nomogram model was 0.752, which confirmed the prediction ability; and was further confirmed by calibration plots results. Conclusion Our data suggest that patients with OL who are over 50 years old, non‐smokers with dysplasia, and OL lesions involving the lip, the floor of mouth, and tongue have an enhanced risk of MT. The established nomogram model has the predictive value of malignant progression, which is conductive to screen high‐risk patients and guide treatment strategy.

The Analysis of the Frequency of Leukoplakia in Reference of Tobacco Smoking among Northern Polish Population

“…Moreover, a study by Rubert et al provides us with information that gender may also influence the risk of malignant transformation of oral leukoplakia. In the study, 57.1% of cases were diagnosed among female patients and 42.9% among male patients, which may lead to a conclusion that female patients might be more prone to malignant transformation of oral leukoplakia [ 29 ], which is the opposite result of the research conducted by Jayasooriya et al [ 28 ], Wang et al [ 27 ], and meta-analysis prepared by Matulić et al, which also revealed that there were no statistically significant differences in malignant transformation of oral leukoplakia between male and female patients [ 30 ]. Nevertheless, returning to the statement that the age of patients may influence the clinical symptoms of leukoplakia, the study by Rupert et al also seems to confirm this [ 29 ].…”

“…Mostly higher incidence of leukoplakia, in men aged 41–60 years, has also appeared in the work of some authors [ 8 , 18 , 25 ], although some investigators have shown that the incidence of leukoplakia in women and men is equal [ 4 ], or even higher in women [ 17 ]. According to Wang et al, in a retrospective study including 875 patients from a Chinese population, women more often had oral leukoplakia (the ratio of men to women for oral leukoplakia was 1:2) and the malignant transformation rate in women (14.4%) was higher than in men (9.4%) [ 27 ]. In our retrospective study, leukoplakia was diagnosed slightly more often in men, but women accounted for 47.1% of all diagnosed patients (220 men and 196 women with leukoplakia lesions).…”

“…In this group of patients, only 18.9% were smokers and 12.9% consumed alcohol. However, the malignant transformation rate of oral leukoplakia among currently smoking patients was lower (3%) than among non-smokers or former smokers (14.4%) and there were no significant differences in malignant progression between women and men [ 27 ]. In our study, the highest incidence of leukoplakia was found in the age group 41–60, which constituted 46.6% of patients diagnosed with leukoplakia, where a slight advantage was noted in men (98 men to 96 women).…”

DNA aneuploidy with image cytometry for detecting dysplasia and carcinoma in oral potentially malignant disorders: A prospective diagnostic study

“…Moreover, the proportion (14.5%) was within the rate (12.2%-17.9%) of malignant transformation of oral leukoplakia from China. 24,25 Although it was moderate efficacy that that AUC of DNA aneuploidy was 0.735 (sensitivity, 61.5%; specificity, 77.5%) for discrimination of dysplasia from general OPMD, it was well-recognized efficacy that the AUC of DNA aneuploidy was 0.851 (sensitivity, 84.5%; specificity, 80.2%) for detection of carcinoma in general OPMD. Correspondingly, the optimal criteria of DNA aneuploidy were classified from at least one aneuploid cell with DI ≥ 2.3 to aneuploid cell with DI ≥ 3.5.…”

Management of oral leukoplakia: a position paper of the Society of Oral Medicine, Chinese Stomatological Association

“…Oral leukokeratosis that will subside after the control of local factors such as smoking and local physical stimulation is not included in this category. With a high risk of malignant transformation (estimated overall rate: 3.5%, range from 0.13% to 34.0%), [3][4][5][6] OLK can affect the physical and mental health of patients to various degrees. [7][8][9] According to the clinical manifestations, OLK can be classified into 2 types with significant differences in the rate of malignant transformation: homogeneous vs nonhomogeneous (3.0% vs 14.5%, P < .01).…”