Review

口腔白斑的恶性转化：系统综述与全面Meta分析

Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis

ORAL DISEASES

影响因子:2.9

分区:医学3区 / 牙科与口腔外科4区

发表日期:2025 Jan

作者: Liliana Aparecida Pimenta-Barros, Pablo Ramos-García, Miguel Ángel González-Moles, José Manuel Aguirre-Urizar, Saman Warnakulasuriya

DOI: 10.1111/odi.15140

摘要

为更新关于口腔白斑（OL）恶性转化的最新证据，全面检索全球范围内所有相关研究，严格筛选符合条件的文献。检索数据库包括MEDLINE、Embase、Web of Science和Scopus，截止至2024年6月，未设下限。采用Joanna Briggs协会工具分析偏倚风险，进行Meta分析、异质性检测及潜在预后指标的风险因素识别。共纳入55项研究（41,231例OL病例）。整体合并的恶性转化比例为6.64%（95% CI：5.21%—8.21%）。不同时间段的转化率无显著差异（p=0.75）：1978年前为5.35%、1979-2007年为7.06%、近年来为6.97%。影响恶性转化的显著危险因素包括非均质性白斑（RR=4.23，95% CI：3.31—5.39）、较大尺寸（RR=2.08，95% CI：1.45—2.96）、舌侧白斑（恶性转化率=12.71%；RR=2.09，95% CI：1.48—2.95）、吸烟（RR=1.64，95% CI：1.25—2.15）以及上皮异型增生（RR=2.75，95% CI：2.26—3.35）。OL具有较高的恶性转化风险，尤其是在吸烟者中表现为大尺寸非均质性病变、位于舌侧、伴有上皮异型增生的病例。

Abstract

To update the current evidence on the malignant transformation of oral leukoplakia (OL), including all studies published worldwide on the subject, selected with the maximum rigor regarding eligibility.MEDLINE, Embase, Web of Science and Scopus were searched for studies published before June-2024, with no lower date limit. The risk of bias was analyzed using the Joanna Briggs Institute tool for meta-analyses of proportions. We carried out meta-analyses, explored heterogeneity across subgroups and identified risk factors with potential prognostic value.Fifty-five studies (41,231 with OL) were included. The pooled malignant transformation proportion for OL was 6.64% (95% CI = 5.21-8.21). The malignant transformation did not significantly vary by time periods (p = 0.75), 5.35% prior to 1978, 7.06% from 1979 to 2007 and 6.97% during more recent times. The risk factors that significantly had a higher impact on malignant transformation were the non-homogeneous leukoplakias (RR = 4.23, 95% CI = 3.31-5.39, p < 0.001), the larger size (RR = 2.08, 1.45-2.96, p < 0.001), leukoplakia located on the lateral border of tongue (malignant transformation = 12.71%; RR = 2.09, 95% CI = 1.48-2.95, p < 0.001), smoking (RR = 1.64, 95% CI = 1.25-2.15, p < 0.001), and the presence of epithelial dysplasia (RR = 2.75, 95% CI = 2.26-3.35, p < 0.001).OL presents a considerable malignant transformation probability that is especially increased in large non-homogeneous lesions in smokers, located on the lateral border of the tongue, with epithelial dysplasia.