Rate of Malignant Transformation Differs Based on Diagnostic Criteria for Oral Lichenoid Conditions: A Systematic Review and Meta-Analysis of 24,277 Patients

Simple Summary Oral lichenoid conditions are common potentially malignant disorders affecting oral mucosa. The 2003 modified WHO criteria is the most widely used criteria in diagnosing oral lichen planus; however, the concern on the implementation of epithelial dysplasia as an exclusion criterion may result in the remarkable underestimation of the potential malignancy of this disease continuing. This systemic review and meta-analysis attempted to provide an objective view by comparing the malignant transformation rate of oral lichen planus diagnosed according to the 2003 modified WHO criteria and non-2003 criteria, and to determine risk variables associated with malignant transformation of oral lichenoid conditions. We found that the malignant transformation rate of oral lichen planus differed based on diagnostic criteria, with lower rates for the 2003 modified WHO criteria than non-2003 criteria, albeit not statistically significant. A higher incidence of malignant transformation was found for red-type lesions and patients who are smokers, alcohol consumers, and HCV positive. Objectives: This systematic review and meta-analysis aims to evaluate the evidence on the malignant potential of oral lichenoid conditions (OLCs) including oral lichen planus (OLP), oral lichenoid lesions (OLL), and lichenoid mucositis dysplasia (LMD). In addition, it aims to compare the rate of malignant transformation (MT) in OLP patients diagnosed according to different diagnostic criteria, and to investigate the possible risk factors for OLP MT into OSCC. Materials and methods: A standardized search strategy was applied across four databases (PubMed, Embase, Web of Science, and Scopus). Screening, identification and reporting followed the PRISMA framework. Data on MT were calculated as a pooled proportion (PP), subgroup analyses and possible risk factors for MT were pooled as odds ratios (ORs). Results: Among 54 studies with 24,277 patients, the PP for OLCs MT was 1.07% (95% CI [0.82, 1.32]). The estimated MT rate for OLP, OLL and LMD was 0.94%, 1.95% and 6.31%, respectively. The PP OLP MT rate using the 2003 modified WHO criteria group was lower than that using the non-2003 criteria (0.86%; 95% CI [0.51, 1.22] versus 1.01%; 95% CI [0.67, 1.35]). A higher odds ratio of MT was observed for red OLP lesions (OR = 3.52; 95% CI [2.20, 5.64]), smokers (OR = 1.79; 95% CI [1.02, 3.03]), alcohol consumers (OR = 3.27, 95% CI [1.11, 9.64]) and those infected with HCV (OR = 2.55, 95% CI [1.58, 4.13]), compared to those without these risk factors. Conclusions: OLP and OLL carry a low risk of developing OSCC. MT rates differed based on diagnostic criteria. A higher odds ratio of MT was observed among red OLP lesions, smokers, alcohol consumers, and HCV-positive patients. These findings have implications for practice and policies.