Meta‐analysis of the predictive value of DNA aneuploidy in malignant transformation of oral potentially malignant disorders

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Excerpt

Oral cancer (oral squamous carcinoma; OC) is a significant burden globally with an annual incidence of 275 000 cases worldwide. The 5‐year survival rate for patients with OC is still low in many parts of the world despite significant progress in diagnosis and treatment.1 There is currently no clear evidence to support the consensus that early diagnosis is the most important factor to improve prognosis, as all data available relate to size of the tumor at diagnosis, which is then extrapolated to suggest early diagnosis as a potential marker of good prognosis.1 OC is often preceded by oral potentially malignant disorders (OPMDs), whose risk can be assessed based on the presence and severity of epithelial dysplasia.3 The prevalence of OPMDs has been reported to be approximately 2% worldwide with an overall transformation rate of 1.36% per year.3 Lack of consensus on the histological assessment for the presence and degree of dysplasia combined with the fact that not all OPMDs with dysplasia transform to cancer have fueled the search for alternative methods to detect those patients with OPMDs at high risk of developing oral cancer.6
DNA aneuploidy is an imbalance of chromosomal DNA content that has been highlighted as a predictor of biological behavior and risk of malignant transformation in several types of human tissues,8 such as Barrett's esophagus, ulcerative colitis, colorectal adenomas, melanocytic skin nevi, cervical as well as oral lesions.9 DNA content, as evaluated using image cytometry (DNA‐ICM) and high‐resolution flow cytometry (DNA‐FCM), permits the detection of abnormal nuclear DNA content. Both DNA‐ICM and DNA‐FCM techniques have been considered appropriate for routine analysis in many clinical applications including OPMDs.6
So far, DNA aneuploidy in OPMDs has been shown to correlate strongly with severe dysplasia 8 and high‐risk lesions that appeared non‐dysplastic can be identified by ploidy analysis.6 Nevertheless, the prognostic value of DNA aneuploidy in predicting malignant transformation of OPMDs remains to be validated.
The aim of this systematic review and meta‐analysis was to assess the role of DNA aneuploidy in predicting malignant transformation in OPMDs.
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