1
|
González-Arriagada WA, Canedo-Marroquin G, Adorno-Farías D, Fernández-Ramires R. New insights into the role of the oral leukoplakia microenvironment in malignant transformation. Front Oral Health 2024; 5:1363052. [PMID: 38450102 PMCID: PMC10914962 DOI: 10.3389/froh.2024.1363052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024] Open
Abstract
Oral leukoplakia is the most frequent and potentially malignant lesion of the oral cavity. Although dysplasia grading remains the main factor for risk assessment, challenges persist in determining the exact risk of transformation, and the literature has focused on studying alternative biomarkers. The interaction between dysplastic epithelial cells and the microenvironment starts early, and the communication is mainly mediated by lymphocytes, inflammatory factors, fibroblasts, and the extracellular matrix, leading to dysplastic progression. Leukoplakia-infiltrating leukocytes (LILs) and leukoplakia-associated fibroblasts (LAFs) play crucial roles in the dysplastic microenvironment. The immune response is related to intraepithelial T lymphocyte infiltration, mechanisms of immunosuppression coordinated by regulatory T cells, M2 macrophage polarization, and increased numbers of Langerhans cells; in contrast, fibroblastic and extracellular matrix factors are associated with increased numbers of pro-tumorigenic myofibroblasts, increased expression of metalloproteinases vs. decreased expression of TIMPs, and increased expression of chemokines and other inflammatory mediators. The microenvironment offers insights into the progression of leukoplakia to carcinoma, and understanding the complexity of the oral microenvironment in potentially malignant diseases aids in determining the risk of malignant transformation and proposing new therapeutic alternatives.
Collapse
Affiliation(s)
- Wilfredo Alejandro González-Arriagada
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
- IMPACT-Center of Interventional Medicine for Precision and Advanced Cellular Therapy, Universidad de los Andes, Santiago, Chile
| | - Gisela Canedo-Marroquin
- Facultad de Odontología, Universidad de los Andes, Santiago, Chile
- Centro de Investigación e Innovación Biomédica, Universidad de los Andes, Santiago, Chile
| | - Daniela Adorno-Farías
- School of Dentistry, Oral Medicine and Pathology Department, Universidad de Chile, Santiago, Chile
| | - Ricardo Fernández-Ramires
- Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
- Grupo Chileno de Cáncer Hereditario, Universidad de los Andes, Santiago, Chile
| |
Collapse
|
2
|
Kallarakkal TG, Zaini ZM, Ghani WMN, Karen-Ng LP, Siriwardena BSMS, Cheong SC, Tilakaratne WM. Calibration improves the agreement in grading oral epithelial dysplasia-Findings from a National Workshop in Malaysia. J Oral Pathol Med 2024; 53:53-60. [PMID: 38081145 DOI: 10.1111/jop.13501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/18/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
INTRODUCTION A major pitfall of many of the established oral epithelial dysplasia (OED) grading criteria is their lack of reproducibility and accuracy to predict malignant transformation. The main objective of this study was to determine whether calibration of practicing oral pathologists on OED grading could improve the reproducibility of the WHO 2017 and the binary OED grading systems. METHODS A nationwide online exercise was carried out to determine the influence of calibration on the reproducibility of the WHO 2017 and the binary OED grading systems. RESULTS A significant improvement was observed in the inter-observer agreement for the WHO 2017 OED grading system (K 0.196 vs. 0.448; Kw 0.357 vs. 0.562) after the calibration exercise. The significant difference (p = 0.027) in the level of agreement between those with five or more years and less than 5 years of experience was no more observed (p = 0.426) after the calibration exercise. The percent agreement for binary grading was significantly higher (91.8%) for buccal mucosal lesions as compared to lesions on the tongue after the calibration exercise. CONCLUSION This study validates the significance of calibration in improving the reproducibility of OED grading. The nationwide exercise resulted in a statistically significant improvement in the inter-observer agreement for the WHO 2017 OED grading system among a large number of oral pathologists. It is highly recommended that similar exercises should be organized periodically by professional bodies responsible for continuing education among oral pathologists to improve the reliability of OED grading for optimal treatment of oral potentially malignant disorders.
Collapse
Affiliation(s)
- Thomas George Kallarakkal
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zuraiza Mohamad Zaini
- Department of Oral and Maxillofacial Clinical Sciences, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Wan Maria Nabillah Ghani
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Lee Peng Karen-Ng
- Oral Cancer Research and Coordinating Centre, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - B S M S Siriwardena
- Department of Oral Pathology, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
| | | | | |
Collapse
|
3
|
Wils LJ, Poell JB, Peferoen LAN, Evren I, Brouns ER, de Visscher JGAM, van der Meij EH, Brakenhoff RH, Bloemena E. The role of differentiated dysplasia in the prediction of malignant transformation of oral leukoplakia. J Oral Pathol Med 2023; 52:930-938. [PMID: 37749621 DOI: 10.1111/jop.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE Oral leukoplakia is the most common oral potentially malignant disorder. Malignant transformation of oral leukoplakia occurs at an annual rate of 1%-7%. WHO-defined classic epithelial dysplasia is an important predictor of malignant transformation of oral leukoplakia, but we have previously shown in a proof of concept study that prediction improves by incorporation of an architectural pattern of dysplasia, also coined as differentiated dysplasia. We aimed to analyze this finding in a larger cohort of patients. METHOD For this retrospective study 176 oral leukoplakia patients were included. Biopsies for all patients were assessed for the presence of dysplasia and analyzed for cytokeratin 13 and 17 expression. Moreover, the inter-observer agreement for the diagnosis of differentiated dysplasia was determined. RESULTS In total, 33 of 176 patients developed oral squamous cell carcinoma during follow-up. Presence of classic epithelial dysplasia increased cancer risk two-fold (HR = 2.18, p = 0.026). Lesions without classic epithelial dysplasia could be further risk-stratified by the presence of differentiated dysplasia (HR = 7.36, p < 0.001). Combined classic epithelial and differentiated dysplasia imparted a seven-fold increased risk of malignant transformation (7.34, p = 0.001). Inter-observer agreement for the diagnosis of dysplasia, including differentiated dysplasia, was moderate (κ = 0.56, p < 0.001). DISCUSSION This study emphasizes the importance of the recognition of the architectural pattern of differentiated dysplasia as a separate entity for risk prediction of malignant transformation of oral leukoplakia. Presence of any pattern of dysplasia results in accurate prediction of malignant transformation risk of oral leukoplakia.
Collapse
Affiliation(s)
- Leon J Wils
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| | - Jos B Poell
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
- Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Laura A N Peferoen
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, Amsterdam, The Netherlands
| | - Ilkay Evren
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Elisabeth R Brouns
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jan G A M de Visscher
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Erik H van der Meij
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
- Otolaryngology and Head & Neck Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Elisabeth Bloemena
- Oral and Maxillofacial Surgery and Oral Pathology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Pathology, Amsterdam, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
- Cancer Center Amsterdam (CCA), Amsterdam, The Netherlands
| |
Collapse
|