ArticleJournal of the National Cancer Institute2020
Oral Leukoplakia and Risk of Progression to Oral Cancer: A Population-Based Cohort Study.
Article in Journal of the National Cancer Institute, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 102 papers, 8 of them syntheses that pooled it.
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Who cites it
102 citing papers in PubMed, 8 syntheses or guidelines pooled it, 172 citations in OpenAlex.
- Predicting Malignant Transformation in Oral Epithelial Dysplasia: A Systematic Comparison of Artificial Intelligence-Based Risk Models and Pathologist-Based Microscopy.Journal of oral pathology & medicine : official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology · 2026Pooled it
- Psychological factors and quality of life in oral mucosal diseases: A systematic review of assessment tools and clinical implications.BMC oral health · 2026Pooled it
- Malignant Transformation of Oral Leukoplakia and Proliferative Verrucous Leukoplakia and Its Biomarker Predictors: A Systematic Umbrella Review.Head & neck · 2026Pooled it
- Exploring oral microbiome in oral squamous cell carcinoma across environment-associated sample types.Microbiology spectrum · 2025Pooled it
- Malignant transformation of oral leukoplakia: Systematic review and comprehensive meta-analysis.Oral diseases · 2025Pooled it
- Malignant transformation rate of oral precancerous disorders to oral cancer: systematic review and meta-analysis of the current evidence.Frontiers in oral health · 2025Pooled it
- Clinical assessment for the detection of oral cavity cancer and potentially malignant disorders in apparently healthy adults.The Cochrane database of systematic reviews · 2021Pooled it
- Diagnostic tests for oral cancer and potentially malignant disorders in patients presenting with clinically evident lesions.The Cochrane database of systematic reviews · 2021Pooled it
- Pattern of Progression of Oral Potentially Malignant Disorders From Real-World Data: A 24-Year Study.Head & neck · 2026Article
- Pattern-Anchored Diagnosis of Oral Epithelial Dysplasia: A Position Paper From COST Action INTERCEPTOR Working Group 2.Head and neck pathology · 2026Review
- Malignant Transformation Risk in Patients With Oral Leukoplakia and Type 2 Diabetes Mellitus.International dental journal · 2026Article
- The PLAU-ITGB1-TGF-β axis orchestrates spatiotemporal reprogramming of fibroblasts at the invasive front to drive dual immunosuppressive niche and immunotherapy resistance in oral squamous cell carcinoma.Cell death & disease · 2026Article
- Clinicopathological characteristics and follow-up outcomes of patients with oral potentially malignant disorders: A 7-year observational cohort study.Scientific reports · 2026Observational
- miR-185 in salivary extracellular vesicles for early diagnosis of malignant transformation in oral leukoplakia: a clinical study.Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico · 2026Article
- Migrasome-transported PTGES amplifies the PGE2 cascade in SPP1Nature communications · 2026Article
- Longitudinal Analysis of Oral Potentially Malignant Disorder Conversion to Malignancy.The Laryngoscope · 2026Article
- Adhesive hydrogel delivering ALA prevents the malignant transformation of oral leukoplakia.Materials today. Bio · 2026Article
- Topical Imiquimod for Oral Cavity Leukoplakia and Dysplasia: A Scoping Review.Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery · 2026Article
- Transcriptomic atlas of premalignant oral squamous cell carcinoma in an aging mouse model reveals an enhanced immune response and dysregulation of head and neck tissue stem cells.bioRxiv : the preprint server for biology · 2026Article
- Integrated Clinical, Histopathological, and Inflammatory Parameters for Predicting Malignant Transformation in High-Risk Oral Potentially Malignant Disorders: A Prospective Study.Head and neck pathology · 2026Article
42 more citing papers are in PubMed but not listed here.
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe optimal clinical management of oral precancer remains uncertain. We investigated the natural history of oral leukoplakia, the most common oral precancerous lesion, to estimate the relative and absolute risks of progression to cancer, the predictive accuracy of a clinician's decision to biopsy a leukoplakia vis-à-vis progression, and histopathologic predictors of progression.
methodsWe conducted a retrospective cohort study (1996-2012) of patients with oral leukoplakia (n = 4886), identified using electronic medical records within Kaiser Permanente Northern California. Among patients with leukoplakia who received a biopsy (n = 1888), we conducted a case-cohort study to investigate histopathologic predictors of progression. Analyses included indirect standardization and unweighted or weighted Cox regression.
resultsCompared with the overall Kaiser Permanente Northern California population, oral cancer incidence was substantially elevated in oral leukoplakia patients (standardized incidence ratio = 40.8, 95% confidence interval [CI] = 34.8 to 47.6; n = 161 cancers over 22 582 person-years). Biopsied leukoplakias had a higher oral cancer risk compared with those that were not biopsied (adjusted hazard ratio = 2.38, 95% CI = 1.73 to 3.28). However, to identify a prevalent or incident oral cancer, the biopsy decision had low sensitivity (59.6%), low specificity (62.1%), and moderate positive-predictive value (5.1%). Risk of progression to oral cancer statistically significantly increased with the grade of dysplasia; 5-year competing risk-adjusted absolute risks were: leukoplakia overall = 3.3%, 95% CI = 2.7% to 3.9%; no dysplasia = 2.2%, 95% CI = 1.5% to 3.1%; mild-dysplasia = 11.9%, 95% CI = 7.1% to 18.1%; moderate-dysplasia = 8.7%, 95% CI = 3.2% to 17.9%; and severe dysplasia = 32.2%, 95% CI = 8.1%-60.0%. Yet 39.6% of cancers arose from biopsied leukoplakias without dysplasia.
conclusionsThe modest accuracy of the decision to biopsy a leukoplakia vis-à-vis presence or eventual development of oral cancer highlights the need for routine biopsy of all leukoplakias regardless of visual or clinical impression. Leukoplakia patients, particularly those with dysplasia, need to be closely monitored for signs of early cancer.
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