Risk of Malignant Transformation in 3173 Subjects with Histopathologically Confirmed Oral Lichen Planus: A 33-Year Cohort Study in Northern Italy

Arduino, Paolo Giacomo; Magliano, Alessandro; Gambino, Alessio; Macciotta, Alessandra; Carbone, M; Conrotto, Davide; Karimi, Dora; Carrozzo, Marco; Broccoletti, Roberto

doi:10.3390/cancers13225740

Cited by 22 publications

(28 citation statements)

References 31 publications

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“…Recently, Arduino et al [ 32 ] have reported that patients with fewer oral sites involved by OLP lesions presented across the years a higher risk of cancer development because such patients are less likely to undergo routine oral consultations. Therefore, although the painful symptomatology is associated with an impaired quality of life, the presence of oral symptoms could be protective in that pain is the most important motivation for OLP patients to seek help and treatment from a clinician [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)

et al. 2022

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Background Oral lichen planus (OLP) is an immune-mediated inflammatory chronic disease of the oral mucosa, with different patterns of clinical manifestations which range from keratotic manifestations (K-OLP) to predominantly non-keratotic lesions (nK-OLP). The aim of the study was to analyze the differences in the clinical, psychological profile and symptoms between Italian patients of the North and Central-South with K-OLP and nK-OLP. Methods 270 K-OLP and 270 nK-OLP patients were recruited in 15 Italian universities. The Numeric Rating Scale (NRS), Total Pain Rating Index (T-PRI), Hamilton Rating Scales for Depression and for Anxiety (HAM-D and HAM-A), Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were administered. Results The Central-South K-OLP (CS-K-OLP) patients reported a higher frequency of pain/burning compared with the K-OLP patients of the North (N-K-OLP) with higher scores in the NRS and T-PRI (p value < 0.001**). The CS-K-OLP and the CS-nK-OLP patients showed higher scores in the HAM-D, HAM-A, PSQI and ESS compared with the Northern patients (p value < 0.001**). Multivariate logistic regression revealed that the NRS and T-PRI showed the greatest increase in the R2 value for the CS-K-OLP (DR2 = 9.6%; p value < 0.001**; DR2 = 9.7% p value < 0.001**; respectively) and that the oral symptoms (globus, itching and intraoral foreign body sensation) and PSQI showed the greatest increase in the R2 value for the CS-nK-OLP (DR2 = 5.6%; p value < 0.001**; DR2 = 4.5% p value < 0.001** respectively). Conclusions Pain and mood disorders are predominant in patients with OLP in the Central-South of Italy. Clinicians should consider that the geographical living area may explain the differences in oral symptoms and psychological profile in OLP.

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Section: Discussionmentioning

confidence: 99%

Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)

et al. 2022

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“…Several factors may limit the life expectancy of patients with LP[ 94 , 95 ]. Oral squamous cell carcinoma is one of them, as oral LP is widely regarded as a precancerous condition, even though the exact rate of malignant transformation is a matter of debate[ 55 , 96 - 99 ].…”

Section: Main Bodymentioning

confidence: 99%

Esophageal lichen planus: Current knowledge, challenges and future perspectives

Decker¹,

Schauer²,

Lazaro³

et al. 2022

World J Gastroenterol

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Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options.

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“…Compared to other OPMDs, 4–8 OLP has a lower MT rate potential, but it has been estimated that OLP has a cumulative MT rate of 1.4% (99% CI 0.9–1.9), with a yearly MT rate of 0.28% 9 . Arduino et al in a recently published study 10 conducted on 3173 OLP patients with a long‐term follow‐up confirmed this conclusion. Although there is a substantial amount of research on progression to cancer, 11–13 a specific analysis regarding SCC developed on OLP lesions and its differences with SCC in patients without a history of OLP has not been investigated so far.…”

Section: Introductionmentioning

confidence: 98%

Oral cavity carcinoma in patients with and without a history of lichen planus: A comparative analysis

Iocca¹,

Copelli

Rubattino³

et al. 2023

Head & Neck

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Background Oral potentially malignant disorders (OPMD) are associated with the risk of malignant transformation (MT) into oral cavity carcinoma (OCC). Oral lichen planus (OLP) is one of the most common OPMDs in western countries. Although there is a substantial amount of research on progression to cancer, a specific analysis of the clinical characteristics and prognosis of cancer developed in patients with a history of OLP versus patients without a history of OLP has not been investigated so far. Methods Retrospective evaluation of 82 patients treated for OCC with a known history of OLP compared to a representative sample of 82 patients treated for OCC without a known history of LP. Comparative analyses were performed on age at presentation, sex, TNM staging, clinical characteristics, pathology characteristics, 2‐ and 5‐year overall survival (OS), and disease‐free survival (DFS). Results It was shown that patients with a history of LP were significantly younger at first presentation than patients without a history of LP (mean age difference 6.7 years, 95% CI 3.1–10.3, p < 0.05). Also, patients with a history of OLP were in higher proportion females. The main pathological stage at presentation was significantly lower in the OLP group (p < 0.05). The 2‐year survival analysis showed that DFS and OS were significantly lower in patients without a known history of OLP, with a hazard ratio (HR) of 3.1 (95% CI 1.4–6.8) and HR of 2.6 (95% CI 1.3–5.3), respectively. The 5‐year survival analysis showed that DFS and OS were significantly lower in patients without a known history of OLP, with a hazard ratio of 3.1 (95% CI 1.6–6.2) and of 2.9 (95% CI 1.5–5.6), respectively. Conclusions Cancer arising from OLP has peculiar characteristics compared to cancer in naïve patients. It most commonly affects younger patients, women, and nonsmokers. It is usually diagnosed at earlier stages and appears to have less aggressive behavior at presentation. Moreover, when 2‐ and 5‐year survival is analyzed, it appears that patients in OLP group have an overall and a disease‐free survival advantage. These results suggest that cancer from OLP is less aggressive and thus has a potential biological difference with cancer arising in non‐OLP patients. Further clinical and basic investigations are needed to confirm the results of this study.

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Risk of Malignant Transformation in 3173 Subjects with Histopathologically Confirmed Oral Lichen Planus: A 33-Year Cohort Study in Northern Italy

Cited by 22 publications

References 31 publications

Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)

Where do you live? North versus Central-South differences in relation to Italian patients with oral lichen planus: a cross-sectional study from the SIPMO (Italian Society of Oral Pathology and Medicine)

Esophageal lichen planus: Current knowledge, challenges and future perspectives

Oral cavity carcinoma in patients with and without a history of lichen planus: A comparative analysis

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