Pattern of Progression of Oral Potentially Malignant Disorders From Real-World Data: A 24-Year Study

Background: Oral potentially malignant disorder (OPMD) prognostication is limited by uncertainty of which lesions will progress and the aggressiveness of lesion progression. We defined patterns and kinetics of progression in a large cohort of OPMD subjected to serial clinical and histologic examinations. Methods: This 24-year study evaluated the pattern of disease progression in 668 patients with 1313 OPMDs. Results: The disease progression pattern was grouped as (a) non-progressive (82.5%), (b) progressive, where initial low-grade dysplasia advanced to high-grade dysplasia in subsequent lesions (5.8%), and (c) transformed, where dysplastic lesions transformed into squamous cell carcinoma (11.7%). Progression showed aggressive (< 2 years) and indolent (> 2 years) patterns. An aggressive course occurred in 48.3% of progressive and 57.6% of transformed lesions. Progression was associated with high-grade lesions, floor of mouth and palate subsites, and tobacco and alcohol use. Conclusions: The data from this study may be used to develop a risk-stratified approach for OPMD management.