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

• Published in: PloS one Vol. 14; no. 12; p. e0225682
• Main Authors: Sundberg, Jonas, Korytowska, Magdalena, Holmberg, Erik, Bratel, John, Wallström, Mats, Kjellström, Ebba, Blomgren, Johan, Kovács, Anikó, Öhman, Jenny, Sand, Lars, Hirsch, Jan-Michaél, Giglio, Daniel, Kjeller, Göran, Hasséus, Bengt
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.12.2019; Public Library of Science (PLoS)
• Subjects: Adult; Age; Aged; Aged, 80 and over; Alcohol; Alcohol use; Analysis; Biology and Life Sciences; Cell cycle; Cell Transformation, Neoplastic - pathology; Clinical Medicine; Dentistry; Diagnosis; Drinking (Alcoholic beverages); Dysplasia; Female; Follow-Up Studies; Genetic transformation; Health aspects; Hospitals; Humans; Incidence; Klinisk medicin; Lasers; Leukokeratosis; Leukoplakia, Oral - epidemiology; Leukoplakia, Oral - etiology; Leukoplakia, Oral - pathology; Leukoplakia, Oral - surgery; Longitudinal Studies; Male; Maxillofacial surgery; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Mouth Mucosa - pathology; Mucosa; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - etiology; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - prevention & control; Odontologi; Odontology; Oncology; Oral cancer; Oral Surgical Procedures; Pathogenesis; Pathology; Patients; Prospective Studies; Risk Factors; Smoking; Social Sciences; Statistical analysis; Studies; Surgery; Surveillance; Systematic review; Tobacco; Tobacco, Smokeless - adverse effects; Treatment Outcome; Women; Young Adult; Sweden
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0225682

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.