Malignant transformation of oral submucous fibrosis: A systematic review and meta‐analysis

Abstract

Objectives: This systematic review and meta-analysis aimed to determine the proportion of patients who develop oral carcinomas following a diagnosis of oral submucous fibrosis (OSF) in reported longitudinal studies. We also aimed to evaluate the demographic and clinicopathological factors contributing to the progression of OSF to cancer.Methods: Individual search strategies were applied for the following bibliographic databases: MEDLINE by PubMed, Scopus, Embase, Web of Science, and Grey literature databases until August 30, 2020. Methodological assessment of the risk of bias of the included studies was undertaken using the modified Newcastle-Ottawa scale.Meta-analyses were conducted using a random-effects (DerSimonian and Liard) method to calculate the pooled proportion of the malignant transformation (MT) in OSF patients.Results: Out of 585 records screened, a total of 9 observational studies were included with a total number of 6,337 patients; of these, 292 OSF cases developed carcinomas. The pooled proportion of the MT was 4.2% (95% CI: 2.7%-5.6%) with an annual transformation rate of 0.73%. Subgroup analysis revealed that the pooled MT proportion was significantly higher among population-based studies in comparison with hospital-based ones (p < .005). Most of the studies showed a high risk of bias. In several studies, there was a lack of information about the demographic and clinicopathological characteristics of OSF patients and associated risk indicators; this insufficiency in details hindered the ability to conduct further subgroup analyses.Conclusions: Despite the poorly reported and the limited number of studies, our analysis confirms that close to 4% of patients diagnosed with OSF may develop oral cancer. Cases with oral epithelial dysplasia had a higher potential for malignant transformation.

Malignant Transformation Rate of Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis

“…Whilst a recent systematic review and meta-analysis calculated the MTR at 4%, the authors noted the limited availability of studies [ 10 ]. “The aim of this systematic review was to collate and analyse the existing literature on oral submucous fibrosis (OSF) and establish the overall malignant transformation rate (MTR).…”

Management of oral potentially malignant disorders

“…OSCC development in patients from India with OSF seems to be associated with better prognosis compared to those without OSF (P. Chaturvedi et al, 2017). There is some evidence to suggest that the risk for cancer development in patients with OSF is higher in patients with co-existing OL/OE or dysplasia compared to those without (Kujan et al, 2020). However, given the rate for cancer development is close to 1% per year (Iocca et al, 2020) In terms of risk stratification, there are low evidence studies exploring predictive biomarkers for cancer development in OSF.…”

“…This special issue on OMPDs provides updates on the epidemiology, diagnostic criteria (Warnakulasuriya, 2020), and biomarkers predicting cancer development for this diverse group of disorders including leukoplakia/erythroplakia (OL/OE) (Monteiro et al, 2020;Odell, 2021), proliferative verrucous leukoplakia (PVL) , oral submucous fibrosis (OSF) (Kujan et al, 2020), and oral lichen planus/oral lichenoid lesions (OLP/OLL) The unifying theme of all OPMDs is their potential risk for cancer development (i.e., squamous cell carcinoma (OSCC), and to a lesser extent, verrucous carcinoma). Yet, the natural history of OPMDs is variable and unpredictable and the inevitability of cancer development is not assured.…”

Oral potentially malignant disorders: Proceedings from an expert symposium

“…The subsequent five articles through systematic review and meta-analysis cover malignant transformation of a range of OPMDs (leukoplakia, proliferative verrucous leukoplakia, lichen planus and lichenoid reactions, and oral submucous fibrosis) providing the estimated proportions of OPMDs that transform to cancer (Table 1) (Aguirre-Urizar et al, 2021;Ramos-García et al 2021a;Ramos-García et al 2021b;González-Moles et al 2020;Kujan et al, 2020). As seen in Table 1, among OPMDs, proliferative verrucous leukoplakia (PVL) has the highest risk to transform to malignancy.…”