Malignant Transformation in Oral Lichen Planus
Research type
Research Study
Full title
Malignant Transformation in Oral Lichen Planus
IRAS ID
299779
Contact name
Caroline McCarthy
Contact email
Sponsor organisation
University of Liverpool, Head of Operations
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
Research Summary
Oral Lichen Planus (OLP) is a chronic autoimmune condition of unknown aetiology which affects around 2% of the population. It is a potentially malignant oral disorder. Whilst the malignant transformation rate of OLP is low, around 1% in 7 years, certain high-risk features are recognised, including: erosive phenotype, tongue site and female gender, smoking, alcohol and hepatitis C infection. Treatment for oral cancer can result in significant morbidity and around 50% of patients will die from their disease within five years of diagnosis. Early detection is critical to improving the survival rates and permitting less invasive treatment to reduce the associated morbidity.
Liverpool University Dental Hospital Oral Medicine Department manages a large cohort of patients with OLP. Liverpool has a high rate of Oral Cancer, far exceeding the national average. Therefore, this project seeks to explore the rate of oral cancer development within a cohort of patients with OLP, in an area with high rates of oral cancer. These results can be compared to published international figures for oral cancer development in oral lichen planus and could be used as a basis for the planning of larger, multi-centre studies in this field. Patients with lichen planus and oral cancer development will be identified from hospital records and will be pseudoanonymised prior to data collection.Summary of Results
Background Oral Lichen Planus (OLP) is a chronic skin and mucosal condition of unknown cause which affects around 2% of the population. Oral cancer can develop in patients with OLP. This is referred to as malignant transformation. The malignant transformation rate in OLP is low, reported as 1% in 7 years. There are some factors that seem to increase the risk of this including: erosive phenotype (presence of ulceration in the context of OLP), lesions of the tongue and female gender, smoking, alcohol and hepatitis C infection. This project aims to discover risk factors for malignant transformation in OLP within a UK cohort as there is a limited amount of knowledge of risk factors within this specific population.
Methods
A case-control study design was selected and potentially eligible cases were identified through a systematic search of a hospital database; controls were randomly selected from the same database at a ratio of 2:1 to increase power. Ethical approval was obtained (REC ref: 21/NW/0152). Data were collected on patient demographics, clinical and histological features, management and outcome. Descriptive statistics were used to describe differences between cases and controls and logistic regression to examine the association between independent variables and the outcome of oral cancer.Results
Data from 26 cases and 62 controls was included in the analysis. There was no statistically significant difference between cases and controls in age at presentation, smoking habits, alcohol, or deprivation indices. The presence of reticular disease (white lacy lines) was associated with lower odds of developing oral cancer (OR 0.35 95% CI 0.13-0.94). Prescription of systemic prednisolone was associated with greater odds of oral cancer development (OR 3.44 95%CI 1.26-9.40).Conclusion
The development of oral cancer on a background of oral lichen planus does not appear to be associated with traditional risk factors for oral cancer (smoking and alcohol). This small study demonstrates patients requiring systemic prednisolone have greater odds of developing oral cancer; however, this is likely to be a confounder for severe OLP, which is often erosive in nature. Likewise, those with reticular disease appear to be less likely to develop oral cancer. Larger collaborative studies are required to explore these findings.REC name
North West - Haydock Research Ethics Committee
REC reference
21/NW/0152
Date of REC Opinion
19 May 2021
REC opinion
Favourable Opinion