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ORIGINAL RESEARCH
0194-5998/$32.00 2007 American Academy of OtolaryngologyHead and Neck Surgery Foundation. All rights reserved.
doi:10.1016/j.otohns.2006.09.023
Downloaded from oto.sagepub.com at UT SOUTHWESTERN MEDICAL CTR on May 30, 2016
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METHODS
A retrospective review was conducted of all cases of newly
diagnosed SCCA involving the oral cavity and oropharynx
from January 1, 1992 through December 31, 2004 at our
tertiary care head neck cancer center. This study was approved by our hospitals human studies research committee
and conducted in compliance with the Healthcare Information Portability and Accountability Act. Cases with an associated diagnosis of oral cavity lichen planus were identified by review of pathological diagnoses, cross-referencing
a prospectively maintained International Classification of
Diseases (ICD-9) diagnosis database, and/or review of
surgical procedure logs. Medical records, electronic medical records, and radiographic studies were reviewed for
each case of OLP. Data were collected for date of first
diagnosis of lichen planus, age, gender, tobacco and
alcohol use, and pathological subtype of OLP. Additional
data were collected for the diagnosis of SCCA including
age at diagnosis, primary site, AJCC stage, radiographic
findings, and treatments administered including surgery,
radiation, and chemotherapy. Follow-up data were obtained including disease-free interval, time to first recurrence, subsequent therapy, and overall survival.
Control patients were obtained from the Surveillance, Epidemiology and End Results database for the time period 19732001. Control patients were matched 2:1 according to primary
site, age at SCCA diagnosis (within five years), gender, and
TNM stage.6,7 Survival comparisons were conducted between
the control patients and the OLP patients with respect to overall
survival with the Kaplan-Meier method and the log-rank test
with statistical significance set at P 0.05.
RESULTS
Upon initial review, 13 cases of SCCA associated with oral
lichen planus were identified. Three cases were excluded
Table 1
Description of study population with oral SCCA arising in the setting of OLP
Subject
Gender
Age (y) at
OSCCA
diagnosis
1
2
3
4
5
F
F
F
F
F
43
87
80
57
59
6
7
8
9
10
F
F
F
F
F
79
75
70
63
71
TNM stage at
diagnosis
T1
T1
T2
T4
T4
Duration of
follow-up (m)
Status at study
conclusion*
143.4
44.9
15.2
14.5
13.9
ADF
AWD
AWD
DOD
ADF
9.7
24.9
9.8
77.6
0.6
ADF
ADF
ADF
AWD
AWD
N0 M0
N0 M0
N0 M0
N1 M0
N2b M0
T1 N0 M0
T2 N0 M0
T2 N0 M0
T2 N0 M0
T4a N2b M0
*ADF, alive, disease-free; AWD, alive with disease; DOD, died of disease.
Muoz et al
DISCUSSION
The malignant transformation from OLP to OSCCA remains controversial for several reasons. First, the discrepancy that exists in pathologic diagnosis between OLP, li-
Figure 1 Kaplan-Meier survival curves for oral SCCA in patients with oral lichen planus and control patients.
403
404
CONCLUSIONS
In summary, OLP-related OSCCAs may have a different
profile of clinical behavior than OSCCAs that arise in patients without pre-existing OLP. OLP subjects may have a
higher risk of recurrence in the primary site and a higher
incidence of formation of a second primary tumor, but
despite this they may also have longer actuarial survival.
Further research and closer surveillance of this population is
needed to better inform our understanding of OLP and its
relationship to OSCCA.9
REFERENCES
1. Epstein JB, Wan LS, Gorsky M, et al. Oral lichen planus: Progress in
understanding its malignant potential and the implications for clinical management. Oral Surg Oral Med Oral Pathol 2003;96(1):327.
(Grade D).
2. van der Meij EH, Schepman K, vander Waal I. The possible premalignant character of oral lichen planus and oral lichenoid lesions: A
prospective study. Oral Surg Oral Med Oral Pathol 2003;96(2):164 71.
(Grade B).
3. Gandolfo S, Richiardi L, Carrozzo M, et al. Risk of oral squamous cell
carcinoma in 402 patients with oral lichen planus: a follow-up study in
an Italian population. Oral Oncol 2004;40:77 83. (Grade B).
4. Ogmundsdottir HM, Hilmarsdottir H, Astvaldsdottir A, et al. Oral
lichen planus has a high rate of TP53 mutations. A study of oral mucosa
in Iceland. Oral Surg Oral Med Oral Pathol 2002;93(5):586 92.
5. Mignogna MD, Lo Russo L, Fedele S, et al. Clinical behaviour of
malignant transforming oral lichen planus. Eur J Surg Oncol 2002;28:
838 43. (Grade C).
6. Bhattacharyya N, Nayak VK. Survival outcomes for second primary
head and neck cancer: a matched analysis. Otolaryngol Head Neck Surg
2005;132:63 8.
7. Bhattacharyya N. A matched survival analysis for squamous cell carcinoma
of the head and neck in the elderly. Laryngoscope 2003;368 72.
8. Hietanen J, Paasonen MR, Kuhlefelt M, et al. A retrospective study of
oral lichen planus patients with concurrent or subsequent development
of malignancy. Oral Oncol 1999;35:278 82. (Grade B).
9. van der Meij EH, van der Waal I. Lack of clinicopathologic correlation
in the diagnosis of oral lichen planus based on the presently available
diagnostic criteria and suggestions for modifications. J Oral Pathol Med
2003;32(9):50712. (Grade D).