211例口腔白斑的临床分析

目的：研究口腔白斑癌变和发病部位以及临床表现的关系。方法：对１８年来在我院就诊的２１１例临床和组织确诊为口腔白斑的患者进行了综合分析。结果：龈、舌、颊等部位为白斑高发区，其中有１４例白斑癌变，癌变率为６．６４％。结论：口腔白斑类型以颗粒型、溃疡型、疣状型癌变率较高。癌变高发部位为舌部，舌部又以舌侧缘（包括舌腹和舌缘）的癌变率为著。     

口腔粘膜白斑癌变的分析

作者对经临床和组织学确诊的235例口腔粘膜白斑患者进行l～16年追踪随访,有32例白斑恶变,癌变率为13.6％。其中男性18例,占男性白斑数的11.8％;女性14例,占女性白斑数的16.9％。癌变组平均年龄为53.4岁。白斑类型以颗粒型和疣状型恶变率较高。癌变损害部位以舌部白斑恶变率最高占75％,尤以舌缘、舌腹损害为多。白斑出现疼痛,局部充血红斑,损害迅速扩大、糜烂、增殖质硬等,都可能为恶变的征兆。本组32例,术后随访到20例,有2例复发,术后中位生存期为8.5年。预后较好。     

白斑癌变危险因素与口腔白斑病分期体系的关系

目的：通过对209例口腔白斑患者癌变危险因素与LSCP分期分级关系的综合分析，探讨LSCP分期分级方法的临床意义。方法：首先进行单因素卡方检验，观察性别、病史、吸烟、饮酒，病损数、部位、大小、临床类型及病理分型与LSCP分期体系的关系。筛选对LSCP分期有意义的变量选入多元Logistic回归分析模型。其次对这些因素在LSCP分期中患Ⅳ期白斑相对于Ⅰ、Ⅱ、Ⅲ期白斑的危险性进行分析，并观察各因素对LSCP分期分级的影响。结果：性别、部位、损害类型及病理分型被选入多元Logistic回归分析模型。多元Logistic回归分析表明，女性患者白斑的危险性是男性的2．49倍，舌部及口底白斑危险性高于其他部位，疣 状白斑的危险性是均质型白斑的10．00倍，中度异常增生白斑的危险性是单纯增生或轻度异常增生性白斑的276．48倍，重度异常增生是单纯增生或轻度异常增生性白斑的499．55倍。重度异常增生白斑对LSCP分期的贡献最大。结论：LSCP分期体系可以全面描述白斑的499．55倍，重度异常增生白斑对LSCP分期的贡献最大。结论：LSCP分期体系可以全面描述口腔白斑的特点，有助于对病损癌变危险性综合评估，可以指导临床追踪观察和协助选择最佳治疗方案。     

口腔黏膜白斑与念珠菌感染的临床分析

目的：研究口腔白斑念珠菌感染的临床和病理学特征。方法：利用过碘酸雪夫染色诊断念珠菌感染,回顾性分析448例白斑患者的活检组织中念珠菌感染率,并分析年龄、性别、白斑病损部位、白斑上皮异常增生等因素与感染的关系。结果：白斑组织中念珠菌的感染率14．1％。念珠菌性白斑比普通型白斑的上皮异常增生发生率更高（57．1％vs．33．8％）。回归分析显示＞60岁的老年患者、舌部白斑和上皮异常增生是念珠菌易感因素。结论：念珠菌感染和上皮异常增生密切相关。伴有上皮异常增生的舌部白斑的老年患者更易感染念珠菌。     

目标miRNAs在口腔白斑癌变患者唾液中的表达研究

目的：寻找能够准确评估口腔白斑癌变风险的生物标志物指导临床工作。方法：随机收集未经治疗的口腔癌患者、稳定白斑、癌变白斑患者各20例,收集唾液标本,采用RT－qPCR探讨癌变口腔白斑患者唾液miRNA的变化。结果：癌变白斑患者唾液中miR－339－5p、miR－144、miR－－521－3p、miR－429和miR－181a与病变组织中的表达情况一致（P＜0．10）。结论：miRNA表达改变的唾液检测有望成为一种理想的、无创的早期检测癌变口腔白斑的新方法。     

白斑癌变相关基因的表达谱研究

目的 运用cDNA微阵列技术研究口腔白斑组织和口腔鳞癌组织的基因表达谱的变化，为探讨口腔白斑癌变基因提供初步筛选资料。方法 对临床切除的5例口腔白斑和口腔癌组织进行总RNA抽提，逆转录制备探针，纯化后与含有4124个基因的微阵列杂交，杂交后的信号经扫描仪检测和计算机分析后筛选出与白斑癌变相关的基因。结果 对口腔白斑和口腔癌基因表达谱进行分析，发现存在30个差异表达的基因，它们可能与白斑癌变有关。结论 采用cDNA微阵列技术能成功检测出两种不同组织中多个基因的差异表达，为研究白斑癌变机制提供有价值的筛选资料。     

口腔白斑癌变率与癌变时间及其影响因素的回顾分析

目的:回顾1978年—2009年就诊于上海交通大学医学院附属第九人民医院口腔黏膜病专科门诊的口腔白斑病例,统计口腔白斑癌变率和癌变时间的基线资料,同时评价影响口腔白斑癌变的相关因素。方法:使用SAS6.12软件包对合适的病例资料进行生存分析(寿命表法和乘积极限法)和Cox回归,分析和描述口腔白斑的癌变率和影响因素。结果:576例口腔白斑中,男350例,女226例,66例癌变,男女各33例,总癌变率为11.46%。适合生存分析和Cox回归的病例共267例,根据病程计算1年癌变率(寿命表法、乘积极限法)为(0.40±0.40)%、(0.86±0.61)%,2年癌变率上升至(2.84±1.15)%、(2.93±1.18)%,5年癌变率达(11.28±2.70)%、(11.31±2.71)%。在多因素分析得出的Cox回归模型中,部位和年龄是影响口腔白斑癌变的主要因素。结论:口腔白斑的癌变率与随访时间有关,影响癌变的主要因素是发病部位和年龄。     

绞股蓝总甙对鼠舌白斑癌变过程中琥珀酸脱氢酶表达影响的研究

目的：探讨中药绞股蓝总甙（Gypenosides,GP）对实验性口腔白斑癌变过程的阻断作用及其对琥珀酸脱氢酶（Succinate dehydrogenaseS,DH）的影响。方法：Wistar大鼠70只,随机分为癌变模型组（n=25）、中药干预组（n=30）、正常对照组（n=5）和中药对照组（n=10）。以4NQO饮水喂养诱导大鼠舌白斑癌变,中药绞股蓝总甙水溶液灌胃干预癌变过程,取9、13、20、24、32周舌背黏膜标本进行组织病理学观察,用实时荧光定量PCR法检测SDH基因表达水平。结果：中药干预组舌背黏膜异常增生发生率明显低于癌变模型组,SDH表达明显高于癌变模型组（P〈0.01或P〈0.05）,尤其在20、24周时。结论：绞股蓝总甙对实验性口腔白斑癌变有阻断作用,通过影响SDH表达以修复三羧酸循环可能是其抗癌机制之一。     

P16在口腔白斑和鳞癌组织中的表达及其意义

目的探讨P16在口腔白斑癌变过程中的变化及其意义。方法免疫组化polymer法检测P16蛋白在口腔白斑和鳞癌组织中的表达情况。结果 P16蛋白在10例正常口腔黏膜组织、16例单纯增生性白斑、10例异常增生性白斑及30例口腔鳞癌组织中表达逐步下降,在正常口腔黏膜组织和单纯增生性白斑中表达强于异常增生性白斑组织和鳞癌组织（P〈0.05）,在异常增生性白斑中表达亦强于鳞癌组织（P〈0.05）。结论 P16蛋白表达下降可以作为口腔白斑癌变的指征之一。     

表皮生长因子受体与口腔白斑癌变关系的初步研究

目的通过检测口腔白斑表皮生长因子受体(epidermal growth factor receptor,EGFR)的表达水平,探讨EGFR与口腔白斑癌变潜力的相关性。方法口腔白斑患者根据手术切除后有无存在癌变分成癌变组和未癌变组,癌变组19例,未癌变组31例,免疫组织化学SP法检测两组白斑标本EGFR的表达水平。结果癌变组的口腔白斑与未癌变组EGFR阳性率分别为73.6%和41.9%,癌变组EGFR阳性率明显高于未癌变组,二者差异有显著性意义。结论EGFR表达水平与口腔白斑癌变存在相关性,EGFR可以作为判断口腔白斑癌变潜力的指标之一。     

The prevalence of oral leukoplakia in 138 patients with oral squamous cell carcinoma

OBJECTIVES: To determine the relationship between oral leukoplakia (OL) and oral squamous cell carcinoma (OSCC), and to evaluate possible differences between those carcinomas with and without associated leukoplakia. MATERIAL AND METHODS: A total of 138 patients were studied at the Stomatology Service of the University General Hospital, Valencia, Spain. These patients were divided into two groups: group 1, patients with oral cancer and leukoplakia, and group 2, patients with OSCC but with no associated premalignant lesions. The relationship between this precancerous lesion and the OSCC was evaluated, as well as the possible clinical and histological differences between the tumours of the two groups. RESULTS: Leukoplakia was detected in 27 (19.56%) patients with OSCC. No differences were found between the two groups regarding age and tumour location. However, statistically significant differences were observed with respect to the form, tumour stage and the presence of adenopathies in the cancers with and without leukoplakia; in that the tumours associated with leukoplakia were diagnosed as being at a more initial stage. CONCLUSIONS: Those patients with OL associated with oral cancer presented with tumours at a less advanced stage than those where no associated leukoplakia existed.     

Concomitant leukoplakia in patients with oral squamous cell carcinoma

OBJECTIVE: There is an ongoing debate on the prevalence of premalignant lesions, in particular leukoplakia, at the time of diagnosis of an oral squamous cell carcinoma (OSCC). The aim of the present study was to determine the presence of concomitant leukoplakia in 100 patients with OSCC, and to evaluate possible differences in clinical and histopathological parameters of the OSCC between those with or without concomitant leukoplakia.PATIENTS AND METHODS: One hundred consecutive patients, 61 men and 39 women, with a histologically proven OSCC were screened on the presence of leukoplakia. Four groups were distinguished: (I) leukoplakia adjacent to the OSCC, (II) combination of leukoplakia adjacent to the OSCC, and leukoplakia at another oral site, (III) leukoplakia present at another oral site, but not adjacent to the OSCC, and (IV) no leukoplakia present.RESULTS: In 47 (47%) patients with OSCC the presence of concomitant leukoplakia was observed. Thirty-six (36%) patients had a leukoplakia adjacent to the OSCC (groups I and II), of which eight (8%) patients (group II) also had a leukoplakia present at another oral site. Eleven (11%) patients (group III) had no leukoplakia adjacent to the OSCC, but a leukoplakia present at another oral site. Fifty-three (53%) patients (group IV) with OSCC had no concomitant leukoplakia present. No differences were noted between men and women, nor was there any preference for an oral subsite with regard to the carcinoma. There were no statistically significant differences in clinical and histopathological presentation of OSCC's between those with or without concomitant leukoplakia.CONCLUSION: Almost 50% of oral squamous cell carcinomas are presumably associated with or preceded by leukoplakia. Early detection and active management of patients with oral leukoplakia may prevent the true development of a number of oral squamous cell carcinomas.     

A comparison of screening methods in two early phase oral leukoplakia clinical trials

Oral Diseases (2012) 18 , 720–723 Objectives/Introduction: Clinical trial accrual for oral dysplasia is difficult in the United States and elsewhere. Patients with dysplastic oral leukoplakia progress to frank invasive carcinoma at a rate of 5–37% over 5 years. We compared two clinical trial screening efforts to hopefully devise better accrual strategies to these types of clinical trials. Methods: For the first trial, we identified 244 patients with dysplastic oral leukoplakia in our university database and a media campaign. Patients were notified and screened by examination and biopsy. For the second clinical trial, we established a preneoplastic lesions clinic and teaching and communications network with regional oral healthcare professionals. Results: Only one of 244 patients accrued to the first clinical trial through an organized screening effort based on database/medical records review. The second clinical trial accrued 16/30 screened patients through redirected efforts in teaching, communications, and a preneoplastic lesions clinic. Conclusion: We conclude that significant difficulties resulted from medical record/database review of leukoplakia patients as a screening method for leukoplakia clinical trial entry. We feel that persistent direct contact and education of healthcare professionals who are likely to examine leukoplakia patients improved accrual to the second clinical trial.     

Patients with oral cancer developing from pre‐existing oral leukoplakia: do they do better than those with de novo oral cancer?

Background:  It has been suggested that patients with squamous cell carcinomas derived from oral leukoplakia have a better prognosis than patients with carcinomas that are not associated with oral leukoplakia.
Aim:  To study the mortality rate of 19 patients with a squamous cell carcinoma derived from pre-existing oral leukoplakia.
Method:  The mortality rate of 19 patients with a proven oral squamous cell carcinoma derived from a pre-existing oral leukoplakia was compared with that of a similar size group of patients with oral carcinoma without a pre-existing oral leukoplakia, being matched for gender, age, smoking habits, use of alcohol, oral subsite and histopathologic grade. Treatment in all patients was primarily by surgical excision. The mortality rates up to 5 years have been computed according to the Kaplan–Meier method.
Result:  No significant difference of the mortality rates up to 5 years of follow-up was observed between the two groups of patients.
Conclusion:  Patients with oral cancer developing from pre-existing oral leukoplakia do not do better than those with de novo oral cancer.     

口腔白斑癌变与吸烟关系的初步探讨

目的：初步探讨口腔白斑的重度上皮异常增生及癌变与吸烟的关系。方法：通过对口腔白斑患者中吸烟者与不吸烟者的临床分型、组织病理变化和吸烟者吸烟情况等临床资料进行综合分析、比较。结果：吸烟者白斑的重度上皮异常增生和癌变发生率明显高于不吸烟者。并且随着吸烟包年数的增加,吸烟者的重度上皮异常增生和癌变发生率也增高,结论：口腔白斑的癌变与吸烟有着一定的联系。     

56例老年口腔黏膜白斑的回顾分析

目的:探讨老年口腔黏膜白斑患者的临床特点。方法:对临床接诊及普查的老年口腔黏膜白斑进行临床观察。结果:男性多发,均质型白斑最常见,颊部最易发,在去除刺激后多可消退。结论:多数白斑无需特殊治疗,位于舌缘的白斑更易癌变。建议对均质型白斑进行早期预防,对其它各型白斑早期手术治疗,特别是位于舌缘的白斑病损。     

Occurrence of oral leukoplakia and lichen planus in diabetes mellitus

The occurrence of oral leukoplakia and lichen planus in 1600 patients with diabetes mellitus (815 type 1: insulin-dependent, 761 type 2: non-insulin-dependent)-under care at the International Medicine Department-was studied. Precancerous lesions and conditions were diagnosed and grouped according to internationally accepted criteria. The prevalence of oral leukoplakia in diabetic patients was 6.2%, as compared to 2.2% in the healthy controls, that of oral lichen was 1.0% in the test-, and 0.0% in the control group. Leukoplakia and lichen both showed the highest occurrence in the second year of established diabetes, and their prevalence was higher among insulin-treated diabetics. Smokers were more often affected, by both kind of lesions, oral lichen showed a more frequent association with candidiasis. The prevalence of oral leukoplakia and lichen in diabetes mellitus patients was higher, than average ratios in population samples from the same country.     

Recurrence patterns of oral leukoplakia after curative surgical resection: important factors that predict the risk of recurrence and malignancy

J Oral Pathol Med (2012) 41 : 682–688 Background: Oral leukoplakia can be treated using a variety of treatment procedures; however, the lesions recur in many cases irrespective of the treatment procedure used. The rate of recurrence was from 7.7% to 38.1%. This study aims to identify the important factors that can lower the risk of recurrence of oral leukoplakia treated by curative surgical resection. Methods: The clinical records of 52 patients with oral leukoplakia (53 lesions) who underwent curative surgical resection between 2004 and 2009 were retrospectively analyzed for the rate of recurrence, clinical outcome, epithelial dysplasia, lesion location, and resection margins. Results: The recurrence rate following curative surgical resection was 15.1%, with the most common site being the gingiva. Malignant transformation occurred in a single patient (1.9%). Minimal resection margins (<3 mm) were observed in many patients with recurrent disease, and recurrence was more likely in cases with positive margins (epithelial abnormalities at the resection margins) than in those with negative margins. There was no significant association between recurrence and the degree of epithelial dysplasia. Conclusions: Our data suggest that surgical resection of oral leukoplakia is curative only if all areas of epithelial abnormalities are identified and resected. Moreover, an adequate resection margin may reduce the risk of recurrence.     

The association between Viadent use and oral leukoplakia--results of a matched case-control study

OBJECTIVES: Several oral pathologists have described oral leukoplakia of the maxillary vestibule in patients with no traditional risk factors for the condition. On questioning these patients, it was determined that Viadent mouthrinse or Viadent toothpaste was commonly used by them. A hypothesis was developed that Viadent or a component of Viadent caused the lesions. This paper evaluates the association between oral leukoplakia and use of Viadent products. METHODS: A matched case-control study was designed to test the hypothesis that use of Viadent products increases an individual's risk of oral leukoplakia. Cases included 58 patients diagnosed with oral leukoplakia identified through the biopsy service at the Ohio State University, College of Dentistry, Oral Pathology Section. The matched control was a friend or relative of the patient. Cases and controls were administered a questionnaire about their use of Viadent, and other known risk factors for leukoplakia such as tobacco and excessive alcohol use. RESULTS: An age difference was seen between cases and controls, the cases being older (P < .001). After controlling for confounding factors, results of exact conditional logistic regression analyses showed that use of Viadent products was a risk indicator for oral leukoplakia (odds ratio = 10.0; 95% confidence interval = 2.0, 89.2). CONCLUSIONS: Viadent use is a risk indicator for oral leukoplakia, confirming our previous findings.