Development and validation of a risk model for noninvasive detection of cancer in oral potentially malignant disorders using DNA image cytometry

Objective:To elucidate whether DNA aneuploidy was an independent discriminator for carcinoma within oral potentially malignant disorders(OPMDs),and further establish and validate a risk model based on DNA aneuploidy for the detection of oral cancer.Methods:A total of 810 consecutive patients with OPMD were prospectively enrolled from March 2013 to December 2018,and divided into a training set(n=608)and a test set(n=202).Brushing and biopsy samples from each patient were processed by DNADNA image cytometry and histopathological examination,respectively.Results:DNA aneuploidy of an outside DNA index≥3.5 in OPMD was an independent marker strongly associated with malignant risk[adjusted odds ratio:13.04;95%confidence interval(CI):5.46-31.14].In the training and test sets,the area under the curve(AUC)was 0.87(95%CI:0.82-0.91)and 0.77(95%CI:0.57-0.97),respectively,for detecting carcinoma in OPMD patients.The independent risk factors of lateral/ventral tongue and non-homogenous type combined with a risk model built with a multivariate logistic regression revealed a more favorable diagnostic efficacy associated with the training set(AUC:0.93;95%CI:0.91-0.96)and test set(AUC:0.94;95%CI:0.90-0.98).The sensitivity and specificity of carcinoma detection within OPMD was improved to 100%and 88.1%,respectively.Conclusions:This large-scale diagnostic study established a risk model based on DNA aneuploidy that consisted of a noninvasive strategy with lateral/ventral tongue and non-homogenous features.The results showed favorable diagnostic efficacy for detecting carcinoma within OPMD,irrespective of the clinical and pathological diagnoses of OPMD.Multicenter validation and longitudinal studies are warranted to evaluate community practices and clinical applications.

Betel quid chewing and oral potential malignant disorders and the impact of smoking and drinking:A meta-analysis

BACKGROUND Oral potential malignant disorders(OPMDs)are a precancerous condition of oral disease.Several studies have found that betel quid chewing,smoking and alcohol drinking might be the risk factors of OPMDs.But the relationships of them,especially their interaction are still inconclusive.AIM To evaluate the relationship between betel quid chewing and OPMDs and to explore the interaction of smoking and alcohol drinking on the relationship.METHODS We searched Pub Med,Web of Science,Embase and the Cochrane Library databases with items complete until January 2021 for relevant studies.The research data were extracted according to the inclusion criteria.The pooled odds ratios(ORs)and 95%confidence intervals(CIs)were used to evaluate the effect size.Subgroup analysis was performed to assess interactions between exposures and OPMDs.Relative excess risk of interaction(RERI)was used to estimate the size of interaction.RESULTS Nine articles were selected in the final meta-analysis.The results showed that betel quid chewing(pooled OR:8.70,95%CI:5.18-14.61),alcohol consumption(pooled OR:1.95,95%CI:1.5-2.55),and smoking(pooled OR:4.35,95%CI:3.06-6.2)could significantly increase the risk of OPMDs compared to individuals without these behaviors.Smoking and alcohol drinking synergistically increased the association between betel quid chewing and OPMDs(pooled OR;:14.38,95%CI:7.14-28.95;pooled OR;:11.12,95%CI:8.00-15.45,respectively).The RERI;and RERI;were 2.33 and 1.47,respectively.CONCLUSION The synergistic effects between smoking/drinking and betel quid highlights the importance of focusing on individuals with multiple exposures.Further study should be conducted to confirm these interactions.