Malignant transformation of oral lichen planus and oral lichenoid lesions: A meta-analysis of 20095 patient data

Publication date: May 2017
Source:Oral Oncology, Volume 68
Author(s): Sana Maher Hasan Aghbari, Abdelrahman Ibrahim Abushouk, Attia Attia, Ahmed Elmaraezy, Amr Menshawy, Mohamed Shehata Ahmed, Basma Abdelaleem Elsaadany, Eman Magdy Ahmed
ObjectivesFor over a century, a heated debate existed over the possibility of malignant transformation of oral lichen planus (OLP). We performed this meta-analysis to evaluate the malignant potential of OLP and oral lichenoid lesions (OLL) and investigate the possible risk factors for OLP malignant transformation into oral squamous cell carcinoma (OSCC).Materials and methodsWe searched Medline, Scopus, and Web of Knowledge for relevant observational studies. Data on OLP malignant transformation were calculated as a pooled proportion (PP), using the Der-Simonian Liard method. We performed subgroup analyses by OLP diagnostic criteria, site, and clinical type, using Open Meta[Analyst] software. Data on possible risk factors for malignant transformation were pooled as odds ratios (ORs), using Comprehensive Meta-Analysis software.ResultsPooling data for OLP malignant transformation from 57 studies (19,676 patients) resulted in an overall PP of 1.1% [95% CI: 0.9%, 1.4%], while pooling data from 14 recent studies that used the World Health Organization-2003 diagnostic criteria resulted in an overall-PP of 0.9% [95% CI: 0.5%, 1.3%]. The risk of malignant transformation was higher (PP=2.5%, 95% CI [1%, 4%]) in OLL patients (419 patients). A significant increase of malignant transformation risk was noted among smokers (OR=2, 95% CI [1.25, 3.22]), alcoholics (OR=3.52, 95% CI [1.54, 8.03]), and HCV-infected patients (OR=5, 95% CI [1.56, 16.07]), compared to patients without these risk factors.ConclusionA small subset of OLP patients (1.1%) develop OSCC; therefore, regular follow-up for these patients is recommended. A higher incidence of malignant transformation was found among smokers, alcoholics, and HCV-infected patients; however, these associations should be further investigated.



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High exhaled nitric oxide levels correlate with nonadherence in acute asthmatic children

Nonadherence to asthma controller medication is associated with an increased number of acute exacerbations, increased asthma-related emergency department visits and childhood hospitalizations, and high health care costs.1 The average medication adherence rate in children with asthma tends to be poor (<50%). Improving patient adherence is essential to achieving optimal outcomes.2

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Preventing food allergies with tweaks to the infant diet

The increase in food allergy prevalence during the past few decades is an important public health concern, galvanizing efforts worldwide to understand and curb this trend. An area of particular interest has been the role of early feeding, particularly feeding of commonly allergenic foods, in the development of allergy. During the past several decades, infant feeding recommendations were made based on available evidence at the time. These recommendations continue to evolve as we gain insight into the multiple factors that influence the development of allergic sensitization to foods.

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Author's response

Motivated by the article by Zazzali et al,1 my editorial2 was intended to elaborate on the possibility of having conflicting conclusions concerning clinical significance vs statistical significance. I would like to thank the authors for their constructive letter3 in support of clinical significance of the effects of omalizumab on angioedema in patients with chronic idiopathic/spontaneous urticaria. The statistical significance of the collective primary outcome differences in patients treated with an active intervention compared with a control is often assessed in terms of the difference in the outcome means for the treatments.

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