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Recurrence rates after surgical removal of oral leukoplakia-A prospective longitudinal multi-centre study.

Journal article
Authors Jonas Sundberg
Magdalena Korytowska
Erik Holmberg
John Bratel
Mats Wallström
Ebba Kjellström
Johan Blomgren
Anikó Kovács
Jenny Öhman
Lars Sand
Jan-Michaél Hirsch
Daniel Giglio
Göran Kjeller
Bengt Hasséus
Published in PloS one
Volume 14
Issue 12
Pages e0225682
ISSN 1932-6203
Publication year 2019
Published at Institute of Odontology
Institute of Clinical Sciences, Department of Oncology
Pages e0225682
Language en
Links dx.doi.org/10.1371/journal.pone.022...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Clinical Medicine, Dentistry

Abstract

Oral leukoplakia (OL) is a potentially malignant oral disorder. The Gold Standard treatment is to remove surgically the OL. Despite optimal surgery, the recurrence rates are estimated to be 30%. The reason for this is unknown. The aim of this study was to investigate the clinical factors that correlate with recurrence after surgical removal of OL. In a prospective study data were collected from 226 patients with OL. Forty-six patients were excluded due to incomplete records or concomitant presence of other oral mucosal diseases. Overall, 180 patients proceeded to analysis (94 women and 86 men; mean age, 62 years; age range, 28-92 years). Clinical data, such as gender, diagnosis (homogeneous/non-homogeneous leukoplakia), location, size, tobacco and alcohol use, verified histopathological diagnosis, and clinical photograph, were obtained. In patients who were eligible for surgery, the OL was surgically removed with a margin. To establish recurrence, a healthy mucosa between the surgery and recurrence had to be confirmed in the records or clinical photographs. Statistical analysis was performed with the level of significance set at P<0.05. Of the 180 patients diagnosed with OL, 57% (N = 103) underwent surgical removal in toto. Recurrence was observed in 43 OL. The cumulative incidence of recurrence of OL was 45% after 4 years and 49% after 5 years. Fifty-six percent (N = 23) of the non-homogeneous type recurred. Among snuff-users 73% (N = 8) cases of OL recurred. A non-homogeneous type of OL and the use of snuff were significantly associated with recurrence after surgical excision (P = 0.021 and P = 0.003, respectively). Recurrence was also significantly associated with cancer transformation (P<0.001). No significant differences were found between recurrence and any of the following: dysplasia, site of lesion, size, multiple vs. solitary OL, gender, age, use of alcohol or smoking. In conclusion, clinical factors that predict recurrence of OL are non-homogeneous type and use of snuff.

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