Development and validation of a nomogram integrating exfoliative cell DNA ploidy and inflammatory-nutritional markers for the prediction of high-grade dysplasia in oral leukoplakia: a cross-sectional diagnostic study.

OBJECTIVE

To develop a noninvasive nomogram combining exfoliative cell DNA ploidy and systemic inflammatory-nutritional markers for high-grade dysplasia (HGD) prediction in oral leukoplakia (OLK).

STUDY

DESIGN

This retrospective diagnostic study included 228 OLK patients. All underwent brush biopsy for DNA image cytometry and blood tests prior to surgical biopsy. Reference standard was histopathology. LASSO and multivariable logistic regression identified predictors for nomogram construction. Performance was evaluated via AUC, calibration, and decision curve analysis.

RESULTS

Of 228 patients, 65 (28.5%) had HGD. DNA aneuploidy (76.9% vs 12.3%, P < .001) and lower Prognostic Nutritional Index (PNI) were independently associated with HGD. The nomogram incorporated DNA ploidy, PNI, clinical type, and smoking history, yielding an AUC of 0.912 in the training set and 0.895 in the validation set, providing significant clinical net benefit.

CONCLUSIONS

Integrating "Локально" DNA ploidy and "systemic" PNI accurately stratifies HGD risk in OLK. This practical tool guides biopsy decision-making and personalizes surveillance strategies.