Hallmarks of Cancer Expression in Oral Lichen Planus: A Scoping Review of Systematic Reviews and Meta-Analyses

Abstract

Oral lichen planus (OLP) is a common chronic inflammatory disease of unknown etiology and likely autoimmune nature that is currently considered an oral potentially malignant disorder, implying that patients suffering from this process are at risk of developing oral cancer in their lifetime. The molecular alterations that develop in OLP and that make the affected oral epithelium predisposed to malignancy are unknown, although, as in other autoimmune diseases (ulcerative colitis, primary biliary cirrhosis, etc.), they may be linked to oncogenesis-promoting effects mediated by the inflammatory infiltrate. So far there is no in-depth knowledge on how these hallmarks of cancer are established in the cells of the oral epithelium affected by OLP. In this scoping review of systematic reviews and meta-analyses the state of evidence based knowledge in this field is presented, to point out gaps of evidence and to indicate future lines of research. MEDLINE, Embase, Cochrane Library and Dare were searched for secondary-level studies published before October 2022. The results identified 20 systematic reviews and meta-analyses critically appraising the hallmarks tumor-promoting inflammation (n = 17, 85%), sustaining proliferative signaling (n = 2, 10%), and evading growth suppressors (n = 1, 5%). No evidence was found for the other hallmarks of cancer in OLP. In conclusion, OLP malignization hypothetically derives from the aggressions of the inflammatory infiltrate and a particular type of epithelial response based on increased epithelial proliferation, evasion of growth-suppressive signals and lack of apoptosis. Future evidence-based research is required to support this hypothesis.

An Evidence-Based Update on the Potential for Malignancy of Oral Lichen Planus and Related Conditions: A Systematic Review and Meta-Analysis

“…Understanding the oncogenic mechanisms linked to autoimmunity is complex, partly as a consequence of the inherent heterogeneity in the development of the immune response. To date, more than 30 primarylevel studies have been published analyzing the influence of the immune response on the malignant transformation of OLP, which frequently report the role of hyperproliferative stimuli and the hyperactivity of oncogenes with tumor suppressor gene responses [144,145]. Nevertheless, there are no systematic reviews or meta-analyses based on evidence regarding this particular subject.…”

Development of an immune-related diagnostic predictive model for oral lichen planus

“…Under the action of exogenous antigens and autoantigens, abnormal apoptosis of oral mucosal keratinocytes mediated by cellular immunity was considered to be closely associated with the progression of OLP lesions. [8][9][10] As the development of next-generation sequencing technology, microarrays combined with bioinformatics analysis have been used widely to identify potential biomarkers for various complex diseases, which has provided new strategies for biomedical research. [11][12][13] Meanwhile, using bioinformatics research, Rivera C et al discovered that CXCL12 and its receptor gene CXCR4 were expected to monitor OLP occurrence and could be new therapeutic targets.…”

“…Under the action of exogenous antigens and autoantigens, abnormal apoptosis of oral mucosal keratinocytes mediated by cellular immunity was considered to be closely associated with the progression of OLP lesions. [8–10]…”

Lichen planus: A Systematic Review

“…The probability of developing cancer in the oral cavity is around 1% in the presence of lichen planus. 9 Recently, many studies have shown the presence of immunological markers in the course of lichen planus, offering prospects for improved diagnostics and modern treatment. This provide hope for non-invasive diagnostic.…”