Dysplasia and DNA ploidy to prognosticate clinical outcome in oral potentially malignant disorders
Corresponding Author
Hans Prakash Sathasivam
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Cancer Research Centre, Institute for Medical Research, National Institute of Health, Setia Alam, Malaysia
Correspondence
Hans Prakash Sathasivam, Cancer Research Centre, Institute for Medical Research, National Institute of Health, 40170 Setia Alam, Malaysia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorDeepa Nayar
King’s College London, Guy’s Hospital, London, UK
Contribution: Formal analysis, Investigation, Methodology, Resources, Writing - review & editing
Search for more papers by this authorPhilip Sloan
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Contribution: Formal analysis, Methodology, Project administration, Resources, Supervision, Writing - review & editing
Search for more papers by this authorPeter J. Thomson
Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
Contribution: Data curation, Investigation, Resources, Writing - review & editing
Search for more papers by this authorEdward W. Odell
King’s College London, Guy’s Hospital, London, UK
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Resources, Supervision, Writing - review & editing
Search for more papers by this authorMax Robinson
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorCorresponding Author
Hans Prakash Sathasivam
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Cancer Research Centre, Institute for Medical Research, National Institute of Health, Setia Alam, Malaysia
Correspondence
Hans Prakash Sathasivam, Cancer Research Centre, Institute for Medical Research, National Institute of Health, 40170 Setia Alam, Malaysia.
Email: [email protected]
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Visualization, Writing - original draft, Writing - review & editing
Search for more papers by this authorDeepa Nayar
King’s College London, Guy’s Hospital, London, UK
Contribution: Formal analysis, Investigation, Methodology, Resources, Writing - review & editing
Search for more papers by this authorPhilip Sloan
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Contribution: Formal analysis, Methodology, Project administration, Resources, Supervision, Writing - review & editing
Search for more papers by this authorPeter J. Thomson
Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, Hong Kong
Contribution: Data curation, Investigation, Resources, Writing - review & editing
Search for more papers by this authorEdward W. Odell
King’s College London, Guy’s Hospital, London, UK
Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Resources, Supervision, Writing - review & editing
Search for more papers by this authorMax Robinson
School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
Department of Cellular Pathology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Supervision, Writing - original draft, Writing - review & editing
Search for more papers by this authorAbstract
Background
Oral potentially malignant disorders are a clinical conundrum as there are no reliable methods to predict their behaviour. We combine conventional oral epithelial dysplasia grading with DNA ploidy analysis to examine the validity of this approach to risk assessment in a cohort of patients with known clinical outcomes.
Methods
Sections from diagnostic biopsies were assessed for oral epithelial dysplasia using the WHO grading system, and DNA ploidy analysis was performed using established methods. Patients reviewed for a minimum of 5 years who did not develop oral squamous cell carcinoma were classified as “non-transforming” cases. Patients that developed oral squamous cell carcinoma ≥ 6 months after the initial diagnostic biopsy were classified as having “malignant transformation.”
Results
Ninety cases were included in the study. Seventy cases yielded informative DNA ploidy results. Of these 70 cases, 31 progressed to cancer. Oral epithelial dysplasia grading and DNA ploidy status were both significantly associated with clinical outcome (P < 0.05). Severe dysplasia had a hazard ratio of 3.50 (CI: 1.46, 8.45; P = 0.005) compared to cases with mild dysplasia. Aneuploidy had a hazard ratio of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to cases with a diploid/tetraploid status. Receiver operating characteristic analysis gave an area under the curve of 0.617 for DNA ploidy status and 0.688 when DNA ploidy status was combined with dysplasia grading.
Conclusion
Our findings suggest that combining dysplasia grading with DNA ploidy status has clinical utility which could be used to develop novel management algorithms.
CONFLICTS OF INTEREST
The authors have no conflicts of interest to declare.
Supporting Information
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