Clinical oral investigations · 2026
Oral squamous cell carcinoma arising from oral epithelial dysplasia shows high postoperative recurrence despite favorable histopathology.
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Hu Yiming, Zhao Xiaoxian, Wang Miao, Zhang Zhiyuan, Jin Shufang, Ma Hailong
Аннотация
OBJECTIVES: We sought to determine whether oral epithelial dysplasia (OED)-derived oral squamous cell carcinoma (OSCC) represents a clinically and pathologically distinct subtype, given that a substantial subset of OSCC is known to arise from OED.
MATERIALS AND METHODS: This retrospective study analyzed 335 patients with OSCC treated at our institution. OED-OSCC was defined as OSCC in patients with a documented history of biopsy-proven oral epithelial dysplasia, irrespective of the specific clinical lesion.
RESULTS: OED-derived OSCC (OED-OSCC), defined by pathologically confirmed dysplasia rather than clinical presentation, comprised 195 (58.2%) patients in the cohort. Compared with non-OED-OSCC, it demonstrated less aggressive tumor-centric features including shallower DOI, lower PNI, earlier T stage, and fewer nodal metastases, yet paradoxically greater cumulative surgical burden with more patients undergoing multiple resections. Recurrence in OED-OSCC was significantly associated with margin dysplasia, which was more frequent than in non-OED-OSCC (74.00% vs. 48.97%). Moreover, recurrence rates increased with margin dysplasia severity (mild: 60%; moderate: 73.08%; severe: 100%), underscoring that field cancerization at the primary site may contribute to the distinct clinical behavior of OED-OSCC. The clinical value of dysplasia-free margins warrants prospective evaluation, as even mild dysplasia was associated with a 60% recurrence rate.
CONCLUSIONS: OED-OSCC represents a pathologically anchored subgroup in which margin dysplasia severity was associated with high recurrence despite favorable tumor-centric features. These findings support prospective evaluation of mucosal margin status in risk stratification.
CLINICAL RELEVANCE: By anchoring OSCC classification to histopathologically confirmed dysplasia, OED-OSCC identifies patients with a dysplastic background and elevated observed recurrence risk who may merit enhanced surveillance.
MATERIALS AND METHODS: This retrospective study analyzed 335 patients with OSCC treated at our institution. OED-OSCC was defined as OSCC in patients with a documented history of biopsy-proven oral epithelial dysplasia, irrespective of the specific clinical lesion.
RESULTS: OED-derived OSCC (OED-OSCC), defined by pathologically confirmed dysplasia rather than clinical presentation, comprised 195 (58.2%) patients in the cohort. Compared with non-OED-OSCC, it demonstrated less aggressive tumor-centric features including shallower DOI, lower PNI, earlier T stage, and fewer nodal metastases, yet paradoxically greater cumulative surgical burden with more patients undergoing multiple resections. Recurrence in OED-OSCC was significantly associated with margin dysplasia, which was more frequent than in non-OED-OSCC (74.00% vs. 48.97%). Moreover, recurrence rates increased with margin dysplasia severity (mild: 60%; moderate: 73.08%; severe: 100%), underscoring that field cancerization at the primary site may contribute to the distinct clinical behavior of OED-OSCC. The clinical value of dysplasia-free margins warrants prospective evaluation, as even mild dysplasia was associated with a 60% recurrence rate.
CONCLUSIONS: OED-OSCC represents a pathologically anchored subgroup in which margin dysplasia severity was associated with high recurrence despite favorable tumor-centric features. These findings support prospective evaluation of mucosal margin status in risk stratification.
CLINICAL RELEVANCE: By anchoring OSCC classification to histopathologically confirmed dysplasia, OED-OSCC identifies patients with a dysplastic background and elevated observed recurrence risk who may merit enhanced surveillance.