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OBJECTIVES: Despite phototherapy (in the form of photodynamic therapy (PDT)-mediated oxidative stress) being utilized in the management of oral potentially malignant disorders (OPMDs), the evidence of certainty remains unclear. Hence, this systematic review and meta-analysis (PROSPERO # CRD42021218748) is aimed to evaluate the clinical efficacy of PDT-induced oxidative stress in OPMDs METHODS: PubMed, Embase, Web of Science, Scopus, and Cochrane Library databases were searched without restriction of language or year of publication. In addition, gray literature was searched and a manual search was performed. Two independent reviewers screened all the studies, assessing data extraction, risk of bias and certainty of evidence. A narrative synthesis was carried out. For the meta-analysis, random effects were considered to determine the prevalence of a total and a partial remission (PR) of oral potentially malignant disorders (OPMDs). The certainty of evidence was explored using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS: Twenty-three studies were included in the qualitative and quantitative syntheses. A total of 880 patients were included (564 males; 218 females) with an age range between 24 and 89-years-old. The results showed the prevalence of the total and partial remissions respectively for the following OPMLs: actinic cheilitis (AC): 69.9% and 2.4%; oral leukoplakia (OL): 44% and 36.9%; oral verrucous hyperplasia (OVH): 98.5%; oral erythroleukoplakia (OEL): 92.1% and 7.9%. The prevalence of no remission of OL was 18.8%. CONCLUSIONS: PDT demonstrated significant results in clinical remission of OPMDs and most of the eligible studies have shown a total or a partial remission of the included lesions, but at a low or a very low certainty of evidence. Hence, further clinical studies with robust methodology are warranted to offer further validated data. Also, further evidence is required to understand further the mechanism of PDT-induced oxidative stress.
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Neoplasias Bucais , Fotoquimioterapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Queilite/tratamento farmacológico , Neoplasias Bucais/tratamento farmacológico , Estresse Oxidativo , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/uso terapêutico , Lesões Pré-Cancerosas/tratamento farmacológico , Resultado do Tratamento , Adulto , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: This study aimed to explore perceived barriers to early diagnosis and management of oral cancer, as well as potential pathways for improvement in Latin America and the Caribbean (LAC). METHODS: This cross-sectional study used a self-administered online questionnaire created via the Research Electronic Data Capture platform. The survey was distributed to health professionals trained in Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, and Dentists with clinical and academic expertise in oral potentially malignant disorder (OPMD) and oral cancer. Data obtained were systematically organized and analyzed descriptively using Microsoft Excel. RESULTS: Twenty-three professionals from 21 LAC countries participated. Major barriers included the limited implementation of OPMD and oral cancer control plans (17.4%), low compulsory reporting for OPMD (8.7%) and oral cancer (34.8%), unclear referral pathways for OPMD (34.8%) and oral cancer (43.5%), and a shortage of trained professionals (8.7%). Participants endorsed the utility of online education (100%) and telemedicine (91.3%). CONCLUSION: The survey highlights major perceived barriers to early diagnosis and management of OPMD and oral cancer in LAC, as well as potential avenues for improvement.
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Detecção Precoce de Câncer , Neoplasias Bucais , Humanos , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/terapia , América Latina , Estudos Transversais , Região do Caribe , Inquéritos e Questionários , Telemedicina , Feminino , Acessibilidade aos Serviços de Saúde , Masculino , Encaminhamento e Consulta , Adulto , Atitude do Pessoal de SaúdeRESUMO
OBJECTIVE: To determine the frequency of oral squamous cell carcinoma (OSCC) associated or not with oral potentially malignant disorders (OPMD), and the epidemiological profile and traditional risk factors in Latin America. METHODS: A retrospective observational study was conducted in 17 Latin American centres. There were included cases of OSCC, analysing age, gender, OSCC and their association with previous OPMD. Clinicopathological variables were retrieved. The condition of sequential-OSCC versus OSCC-de novo (OSCC-dn) was analysed concerning the aforementioned variables. Quantitative variables were analysed using Student's t-test, and qualitative variables with chi-square. RESULTS: In total, 2705 OSCC were included with a mean age of 62.8 years old. 55.8% were men. 53.75% of the patients were smokers and 38% were common drinkers. The lateral tongue border was the most affected site (24.65%). There were regional variations in OPMD, being leukoplakia the most frequent. Of the overall 2705 OSCC cases, 81.4% corresponded to OSCC-dn, while s-OSCC were 18.6%. Regarding lip vermillion SCC, 35.7% corresponded to de novo lip SCC and 64.3% were associated with previous OPMD. CONCLUSIONS: In Latin America, OSCC-dn seems to be more frequent with regional variations of some clinical and histopathological features. Further prospective studies are needed to analyse this phenomenon.
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Delivering bad news has been widely studied in cancer, thus, this scoping review aims to identify the available evidence concerning the communication of oral potentially malignant disorders (OPMDs) and their clinical and psychosocial impacts. A search was performed using electronic databases (Medline/PubMed, Scopus, Embase, and Web of Science) and one grey literature database (Google Scholar). Studies focused on communicating the diagnosis of OPMDs and the patients' perceptions were included. Study selection and data extraction were performed by two authors in a two-phase process. Five publications were included in the qualitative analysis. Differences regarding the study design, population, OPMDs assessed, and outcomes of professional-patient communication were found in each study. Protocols for OPMD communication have not yet been reported and there is a need to standardize strategies as communication skills may provide better clinical outcomes for patients diagnosed with potentially malignant disorders. Although future studies are needed, a brief list recommending the aspects that must be communicated is proposed.
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PURPOSE: High-power diode laser emerges as a promising approach to the treatment of oral leukoplakia (OL); however, its short- and long-term effects have been barely explored. This study evaluated the postoperative endpoints and the recurrence rate of high-power diode laser treatment in a well-defined series of patients with OL. METHODS: A prospective analysis was performed on 22 individuals comprising 31 OL. The lesions were irradiated using the following protocol: Indium-Gallium-Arsenide diode laser, 808 nm, continuous-wave mode, 1.5-2.0 W, 780.0 ± 225.1 J, and 477.1 ± 131.8 s. Postoperative pain was assessed with a visual analog scale at three endpoints. Clinical follow-up was performed on all patients and the Kaplan-Meier test was used to analyze the probability of recurrence. RESULTS: The series consisted mostly of women (72.7%) with a mean age of 62.8 years. A single laser session was performed in 77.4% of cases. The median score on the scale that assessed pain on the 1st, 14th and 42nd postoperative day was 4, 1, and 0, respectively. The mean follow-up period per lesion was 28.6 months (range: 2-53 months). A complete response was observed in 93.5% of OL cases, while 6.5% had recurrence. The probability of recurrence at 39 months was 6.7%. No patient experienced malignant transformation. CONCLUSION: High-power diode laser for the treatment of OL is safe and effective during the trans- and postoperative period. These findings represent an alternative approach to the management of OL, mainly because a low recurrence rate was observed.
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Lasers Semicondutores , Leucoplasia Oral , Humanos , Feminino , Pessoa de Meia-Idade , Lasers Semicondutores/uso terapêutico , Leucoplasia Oral/radioterapia , Leucoplasia Oral/cirurgia , Leucoplasia Oral/patologia , Dor Pós-Operatória , Transformação Celular Neoplásica , Medição da DorRESUMO
PURPOSE OF REVIEW: The aim of this overview is to appraise the evidence on salivary biomarkers for H&N cancer diagnosis. The acronym PICOS was used to develop the eligibility criteria and the focused review question: are liquid biopsies (saliva biomarkers) reliable for cancer detection in H&N cancer patients? Electronic database search encompassed PubMed, EMBASE, Scopus, Cochrane Library, Web of Science, and LILACS. Risk of Bias (RoB) was assessed through AMSTAR 2. RECENT FINDINGS: A total of 20 SRs were included. Only seven SRs were able to reach more solid conclusions around the retrieved findings by calculating the pooled sensitivity, specificity, and the overall area under the curve (AUC). Despite the limitations, significant RoB, and lack of test metrics in primary studies, all SRs recognize and encourage the potential role of saliva in the early diagnosis of oral cancer.
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Neoplasias Bucais , Humanos , Biomarcadores , Detecção Precoce de Câncer , Biópsia Líquida , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/patologia , Revisões Sistemáticas como AssuntoRESUMO
Abstract Type VII collagen (Col7) is a major component of anchoring fibrils. Col7 plays a role in tumor development and aggressiveness of cutaneous squamous cell carcinoma of recessive dystrophic epidermolysis bullosa. However, the role of Col7 in oral squamous cell carcinoma (OSCC) and oral leukoplakia (OL) remains largely unknown. Objective To elucidate the role of Col7 and its diagnostic potential during oral carcinogenesis. Methodology Col7 expression was immunohistochemically studied in 254 samples, including normal oral mucosa (NM), OL without dysplasia, OL with dysplasia, and OSCC. The correlation between Col7 expression and clinicopathologic parameters of OSCC was also determined. Results Col7 was present as a linear deposit at the basement membrane of NM, OL without dysplasia and OL with dysplasia, and at the tumor-stromal junction around tumor islands in OSCC. Discontinuity of expression was frequently observed in OL with dysplasia and OSCC. OSCC had the significantly lowest Col7 expression (p<0.0001). Compared with OL without dysplasia, OL with dysplasia showed significantly reduced Col7 expression. Patients in clinical stage 4 with positive nodes had low Col7 expression compared with those in clinical stage 1 and negative nodes, respectively. Conclusion Loss of Col7 is associated with tumorigenesis and aggressiveness in OSCC. A significantly reduced Col7 expression in OSCC implies that Col7 may be a useful marker for diagnosis and therapeutic targets.
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BACKGROUND: Head and neck cancers are the seventh most common type of cancer worldwide, with almost half of the cases affecting the oral cavity. Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer, showing poor prognosis and high mortality. OSCC molecular pathogenesis is complex, resulting from a wide range of events that involve the interplay between genetic mutations and altered levels of transcripts, proteins, and metabolites. Metabolomics is a recently developed sub-area of omics sciences focused on the comprehensive analysis of small molecules involved in several biological pathways by high throughput technologies. AIM OF REVIEW: This review summarizes and evaluates studies focused on the metabolomics analysis of OSCC and oral premalignant disorders to better interpret the complex process of oral carcinogenesis. Additionally, the metabolic biomarkers signatures identified so far are also included. Moreover, we discuss the limitations of these studies and make suggestions for future investigations. KEY SCIENTIFIC CONCEPTS: Although many questions about the metabolic features of OSCC have already been answered in metabolomic studies, further validation and optimization are still required to translate these findings into clinical applications.
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Neoplasias de Cabeça e Pescoço/metabolismo , Neoplasias Bucais/metabolismo , Carcinoma de Células Escamosas de Cabeça e Pescoço/genética , Carcinoma de Células Escamosas de Cabeça e Pescoço/metabolismo , Biomarcadores Tumorais/metabolismo , Humanos , Metabolômica/métodos , Neoplasias Bucais/genética , Neoplasias Bucais/patologia , Lesões Pré-Cancerosas/genética , Lesões Pré-Cancerosas/metabolismo , Lesões Pré-Cancerosas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologiaRESUMO
Background: Periodontitis has been associated with several systemic diseases and medical conditions, including oral cancer (OC). However, most studies reporting an association between OC and periodontal disease have used different clinical and radiographic criteria to define periodontal disease. This review aimed to evaluate the currently available evidence to determine an association between periodontal disease (extension and severity), OC, and oral potentially malignant disorders (OPMDs).Material and methods: A systematic search of studies published up to August 2018 was performed following the PRISMA guidelines in the electronic databases MEDLINE (PubMed) and COCHRANE (OVID). A methodological evaluation was made using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) checklist.Results: Eight studies (case-control, cross-sectional and cohort) were included. An increased clinical attachment loss, plaque index, bleeding on probing, and radiographic bone loss was found in patients with OC and OPMDs. Differences in the methodological characteristics, case definition used for periodontal diseases, and OC location did not allow estimating the odds ratio required to conduct a meta-analysis.Conclusion: Some studies suggest a positive relationship between periodontal disease, OC, and OPMDs; however, the currently available evidence is insufficient to draw solid conclusions.
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Neoplasias Bucais , Doenças Periodontais , Periodontite , Estudos de Casos e Controles , Estudos Transversais , Humanos , Neoplasias Bucais/complicações , Neoplasias Bucais/diagnóstico , Neoplasias Bucais/epidemiologia , Doenças Periodontais/complicações , Doenças Periodontais/diagnóstico , Doenças Periodontais/epidemiologia , Periodontite/complicações , Periodontite/diagnóstico , Periodontite/epidemiologiaRESUMO
El objetivo de este estudio es determinar la prevalencia de lesiones orales malignas y potencialmente malignas (LPM) en funcionarios de la Universidad de Valparaíso y de Viña del Mar durante los años 2016 - 2017. Fueron citados 161 funcionarios, quienes accedieron a una encuesta que evaluaba factores de riesgo de cáncer oral (tabaco y alcohol) y si habían escuchado de la patología, sumado a un examen clínico. De los pacientes examinados, se diagnosticaron 121 lesiones de las cuales 2 fueron diagnosticadas como lesiones potencialmente malignas: Liquen plano y Leucoplasia, con una prevalencia de 1,7 %. El 50,3 % de los pacientes sabía de la existencia de cáncer oral. El Screening es una medida que permite dar a conocer a la población la existencia de cáncer oral y alertarlos sobre la importancia de su examen para su identificación de manera temprana.
The objective of this study is to determine the prevalence of malignant and potentially malignant oral lesions (PML) in University of Valparaíso and Viña del Mar employees, during the years 2016 - 2017. We cited 161 employees, who accessed a survey evaluating risk factors for oral cancer (tobacco and alcohol) and if they had heard of the disease. In addition, a clinical examination was carried out. Of the patients examined, 121 lesions were diagnosed, of which 2 were diagnosed as potentially malignant lesions: Lichen planus and Leukoplakia, with a prevalence of 1.6 %. 50.3 % of patients knew of the existence of oral cancer. Epidemiological designs are needed to better establish causality between risk factors and malignant or, potentially malignant lesions.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Lesões Pré-Cancerosas/epidemiologia , Neoplasias Bucais/epidemiologia , Programas de Rastreamento/métodos , Lesões Pré-Cancerosas/diagnóstico , Consumo de Bebidas Alcoólicas , Neoplasias Bucais/diagnóstico , Comportamentos Relacionados com a Saúde , Epidemiologia Descritiva , Prevalência , Estudos Transversais , Fatores de Risco , Detecção Precoce de Câncer/métodos , Uso de TabacoRESUMO
BACKGROUND: Scientific literature shows the great potential of fluorescence visualization (FV) in the detection of lesions in the skin and mucosa, though its use has been intermitant. Thus, the aim of this study was to compare the detection of oral cancer and oral potentially malignant disorders (OPMD) with and without the use of fluorescence visualization in population screening. PATIENTS AND METHODS: During a population screening for oral cancer and OPMD, general practice dentists (GPD) performed conventional oral examination (COE) in the first year, and in the second year the FV was inserted in the oral examination. When detecting any suspicious lesion in oral mucosa either by COE or FV, patients were referred for final diagnosis by a specialist in oral medicine. Biopsy was performed in cases of high-risk lesions to confirm the diagnosis, presence of epithelial d (ED), and oral squamous cell carcinoma (OSCC). RESULTS: During the oral cancer prevention campaign in the first year, benign neoplasms were the oral lesions with higher diagnosis rate (26.2%), followed by non-neoplastic proliferative processes (23.8%) and potentially malignant disorders (21.4%). During the second year, with the implementation of the use of FV, OPMD were the lesions with higher diagnosis rate (37.7%). The sensitivity, specificity and accuracy for the detection of potentially malignant disorders were respectively equal to 94.4%, 96.2% and 96.1%. The detection of lesions with epithelial dysplasia for these amounts were respectively equal to 100%, 92.4% and 92.6%. CONCLUSION: FV presented high diagnostic values when used by GPD and improved the detection of OPMD in population screening. FV has potential to be used as an adjunctive method for early diagnosis of oral high-risk lesions.
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Diagnóstico Bucal/métodos , Detecção Precoce de Câncer/métodos , Neoplasias Bucais/diagnóstico , Imagem Óptica/métodos , Lesões Pré-Cancerosas/diagnóstico , Brasil , Fluorescência , Humanos , Neoplasias Bucais/diagnóstico por imagem , Neoplasias Bucais/patologia , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia , Estudos ProspectivosRESUMO
Oral potentially malignant disorders (OPMD) are chronic conditions, which have a higher risk of transformation to oral squamous cell carcinoma. The aim of this systematic review and meta-analysis was to answer the question: "What is the prevalence of oral potentially malignant disorders among adults?" Studies reporting the prevalence of these conditions (leukoplakia, erythroplakia, oral submucous fibrosis [OSMF], and actinic cheilitis) were selected, only studies in which a clinical assessment and histopathological confirmation were performed were included. Of the 5513 studies, 22 met the inclusion criteria for qualitative and quantitative analyses. The risk of bias (RoB) of the selected studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Seven studies were classified as high risk, 12 as moderate risk, and 3 as low RoB. The meta-analysis showed that the prevalence of OPMD was 4.47% (95% CI = 2.43-7.08). The most prevalent OPMDs were OSMF (4.96%; 95% CI = 2.28-8.62) and leukoplakia (4.11%; 95% CI = 1.98-6.97). OPMDs were identified more commonly in males (59.99%; 95% CI = 41.27-77.30). Asian and South American/Caribbean populations had the highest prevalence rates of 10.54% (95% CI = 4.60-18.55) and 3.93% (95% CI = 2.43-5.77), respectively. The overall prevalence of OPMD worldwide was 4.47%, and males were more frequently affected by these disorders. The prevalence of OPMD differs between populations; therefore, further population-based studies may contribute to the better understanding of these differences.
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Carcinoma de Células Escamosas/epidemiologia , Queilite/epidemiologia , Eritroplasia/epidemiologia , Neoplasias Bucais/epidemiologia , Fibrose Oral Submucosa/epidemiologia , Lesões Pré-Cancerosas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Escamosas/etnologia , Queilite/etnologia , Eritroplasia/etnologia , Feminino , Saúde Global , Humanos , Leucoplasia Oral/epidemiologia , Leucoplasia Oral/etnologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/etnologia , Fibrose Oral Submucosa/etnologia , Lesões Pré-Cancerosas/etnologia , Prevalência , Risco , Fatores Sexuais , Adulto JovemRESUMO
The aim of this work was to evaluate the prevalence of TP53Arg72Pro mutations and their possible relationship with oral carcinoma and oral potentially malignant disorders in Argentine patients. A cross-sectional study was performed on 111 exfoliated cytologies from patients with oral cancer (OC), oral potentially malignant disorders (OPMD) and controls. The TP53Arg72Pro mutations were determined using conventional PCR. We evaluated univariate and multivariate study variables, setting p < 0.05. We found: (a) a low frequency of Pro72 variant in control group and a high frequency in OC and OPMD, as well in OC and oral leukoplakia (OL) diagnosis; (b) multivariate association among the TP53CC genotype and females over 45 years with no tobacco nor alcohol habits with oral lichen planus pathology; (c) multivariate association between the TP53GC genotype and males with alcohol and tobacco habits and OC and OL pathologies. Our results showed that the wild-type Arg72variant was related to control patients and Pro72variant was related to OC and OPMD, in Argentine patients.
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Predisposição Genética para Doença , Líquen Plano Bucal/genética , Neoplasias Bucais/genética , Proteína Supressora de Tumor p53/genética , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Argentina , Carcinogênese/genética , Códon , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Leucoplasia Oral/epidemiologia , Leucoplasia Oral/genética , Leucoplasia Oral/patologia , Líquen Plano Bucal/epidemiologia , Líquen Plano Bucal/patologia , Masculino , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Neoplasias Bucais/epidemiologia , Neoplasias Bucais/patologia , Polimorfismo de Nucleotídeo Único/genética , Fatores de Risco , Fatores Sexuais , Nicotiana/efeitos adversosRESUMO
The present study aimed to compare levels of VEGFR2 and MMP-9 among control, epithelial dysplasia (ED) and oral squamous cell carcinoma (OSCC) groups. We analyzed 48 patients with oral leukoplakia (OL), 20 patients with OSCC and 21 patients without OL and OSCC. Immunohistochemistry of VEGFR2 and MMP9 were performed and compared among groups. Analysis of tissue immunolocalization of VEGFR2 and MMP-9 assumed non-parametrical distribution and comparison between groups was performed using the Mann-Whitney and Kruskal-Wallis statistical tests. VEGFR2 and MMP9 immunoexpression appeared to correlate with the degree of dysplasia and was observed to increase in lesions with more severe dysplasia as compared to those with lower degrees of dysplasia. Immunoreactivity of MMP-9 was lower in the OL samples compared to the OSCC samples (p = 0.004). We observed no difference in VEGFR2 protein levels between OL and OSCC samples. A positive correlation was found between VEGFR2 and MMP-9 in OL samples (r = +0.452, p = 0.001), however, no correlation was found in OSCC samples (r = -0.042, p = 0.861). In conclusion, the results of the current study suggest that expression of MMP9 and VEGFR2 is associated with ED grading and MMP9 levels are increased in OSCC.