Oral leukoplakia and risk of progression to oral cancer: A population-based cohort study
Abstract
BACKGROUND
The optimal clinical management of oral precancer remains uncertain. We investigated the natural-history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician's decision to biopsy a leukoplakia vis-à-vis progression, and histopathologic predictors of progression.
METHODS
We conducted a retrospective cohort study (1996-2012) of patients with oral leukoplakia (N = 4,886), identified using electronic medical records within Kaiser Permanente Northern California (KPNC). Among patients with leukoplakia who received a biopsy (n = 1,888), we conducted a case-cohort study to investigate histopathologic predictors of progression. Analyses included indirect standardization and unweighted/weighted Cox regression.
RESULTS
Compared with the overall KPNC population, oral cancer incidence was substantially elevated in oral leukoplakia patients (standardized incidence ratio [SIR]=40.8; 95%CI=34.8-47.6; n = 161 cancers over 22,582 person-years). Biopsied leukoplakias had a higher oral cancer risk compared to those that were not biopsied (adjusted-hazard ratio [HR]=2.38; 95%CI=1.73-3.28). However, to identify a prevalent/incident oral cancer, the biopsy-decision had low sensitivity (59.6%), low specificity (62.1%), and moderate positive-predictive-value (PPV=5.1%). Risk of progression to oral cancer statistically significantly increased with the grade of dysplasia;…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 4,886 participants or records.
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