Predictive value of CDKN2A/p16INK4a expression in the malignant transformation of oral potentially malignant disorders: Systematic review and meta-analysis

BACKGROUND

Management of oral potentially malignant disorders (OPMDs) is still challenging. Despite the diagnostic ascertainment by bioptic examination, this method is poorly informative of the prognosis and subsequent malignant transformation. Prognosis is based on histological findings by grading of dysplasia. Immunohistochemical expression of p16INK4a has been investigated in different studies, with controversial results. In this scenario, we systematically revised the current evidence about p16INK4a immunohistochemical expression and the risk of malignization of OPMDs.

MATERIAL AND METHODS

After a proper set of keywords combination, 5 databases were accessed and screened to select eligible studies. The protocol was previously registered on PROSPERO (Protocol ID: CRD42022355931). Data were obtained directly from the primary studies as a measure to determine the relationship between CDKN2A/P16INK4a expression and the malignant transformation of OPMDs. Heterogeneity and publication bias were investigated by different tools, such as Cochran's Q test, Galbraith plot and Egger and Begg Mazumdar's rank tests.

RESULTS

Meta-analysis revealed a twofold increased risk to malignant development (RR = 2.01, 95% CI = 1.36-2.96 - I2 = 0%). Subgroup analysis did not highlight any relevant heterogeneity. Galbraith plot showed that no individual study could be considered as an important outlier.

CONCLUSION

Pooled analysis showed that p16INK4a assessment may arise adjunct tool to dysplasia grading, leading to an optimized determination of the potential progression to cancer of OPMDs. The p16INK4a overexpression analysis by immunohistochemistry techniques has a multitude of virtues that may facilitate its incorporation in the day-to-day prognostic study of OPMDs.

Oral Chronic Hyperplastic Candidiasis and Its Potential Risk of Malignant Transformation: A Systematic Review and Prevalence Meta-Analysis

Chronic hyperplastic candidiasis (CHC) is a prototypical oral lesion caused by chronic Candida infection. A major controversy surrounding CHC is whether this oral lesion owns malignant transformation (MT) potential. The aim of the present study was to evaluate current evidence on the MT of CHC and to determine the variables which have the greatest influence on cancer development. Bibliographical searches included PubMed, Embase, Web of Science, Scopus and LILACS. The cohort studies and case series used to investigate the MT of CHC were deemed suitable for inclusion. The quality of the enrolled studies was measured by the Joanna Briggs Institute scale. Moreover, we undertook subgroup analyses, assessed small study effects, and conducted sensitivity analyses. From 338 studies, nine were finally included for qualitative/quantitative analysis. The overall MT rate for CHC across all studies was 12.1% (95% confidential interval, 4.1–19.8%). Subgroup analysis showed that the MT rate increased when pooled analysis was restricted to poor quality studies. It remains complex to affirm whether CHC is an individual and oral, potentially malignant disorder according to the retrieved evidence. Prospective cohort studies to define the natural history of CHC and a consensus statement to clarify a proper set of diagnostic criteria are strongly needed. PROSPERO ID: CRD42022319572.

Self-reported depression and anxiety among COPD patients. A case-control study

BACKGROUND

Anxiety and depression are the most prevalent mental disorders worldwide. However, the exact mechanisms linking chronic obstructive pulmonary disease (COPD) with depression and anxiety have not been identified.

OBJECTIVES

To compare self-reported depression and anxiety among patients diagnosed with COPD in relation to healthy controls.

DESIGN AND SETTING

Case control study at a public hospital institution in Spain.

METHODS

We designed a case-control study. Patients were recruited using a consecutive sampling method from a single institution. Two groups were created: COPD and healthy controls. Data on medical history and demographic background were collected from the medical records. Self-reported depression levels were assessed using Beck's depression inventory (BDI). Self-reported anxiety was measured using the State-trait anxiety inventory (STAI).

RESULTS

Fifty-two patients with COPD and fifty healthy patients were included in this study. BDI scores were higher for COPD patients (10.23 ± 6.26) than in the control group (5.2 ± 6.56). STAI-state scores were higher for COPD patients (41.85 ± 12.55) than for controls (34.88 ± 9.25). STAI-trait scores were higher for COPD patients (41.42 ± 10.01) than for controls (34.62 ± 9.19).

CONCLUSIONS

This study showed that there were higher levels of depression and anxiety among COPD patients than among healthy controls.