Page 119 - FINAL COMPENDIUM 2020-2021 27.2.2022

DYSPLASIA AND DNA PLOIDY TO PROGNOSTICATE CLINICAL OUTCOME IN ORAL
POTENTIALLY MALIGNANT DISORDERS

Sathasivam HP, Nayar D, Sloan P, Thomson P, Odell E, Robinson M

Introduction: Oral potentially malignant disorders are a clinical conundrum as there are
no reliable methods to predict their behaviour. Objective: We combine conventional oral
epithelial dysplasia grading with DNA ploidy analysis to examine the validity of this
approach to risk assessment in a cohort of patients with known clinical outcomes.
Materials and methods: Sections from diagnostic biopsies were assessed for oral
epithelial dysplasia using the WHO grading system, and DNA ploidy analysis was
performed using established methods. Patients reviewed for a minimum of 5 years who
did not develop oral squamous cell carcinoma were classified as “non-transforming”
cases. Patients that developed oral squamous cell carcinoma ≥ 6 months after the initial
diagnostic biopsy were classified as having “malignant transformation.” Results: Ninety
cases were included in the study. Seventy cases yielded informative DNA ploidy results.
Of these 70 cases, 31 progressed to cancer. Oral epithelial dysplasia grading and DNA
ploidy status were both significantly associated with clinical outcome (P < 0.05). Severe
dysplasia had a hazard ratio of 3.50 (CI: 1.46, 8.45; P = 0.005) compared to cases with mild
dysplasia. Aneuploidy had a hazard ratio of 2.09 (CI: 1.01, 4.32; P = 0.046) compared to
cases with a diploid/tetraploid status. Receiver operating characteristic analysis gave an
area under the curve of 0.617 for DNA ploidy status and 0.688 when DNA ploidy status
was combined with dysplasia grading. Conclusion: Our findings suggest that combining
dysplasia grading with DNA ploidy status has clinical utility which could be used to develop
novel management algorithms.

Published in J Oral Pathol Med. 2021; 50: 200– 209. https://doi.org/10.1111/jop.13121

Dr Hans P Sathasivam Prof. Dr Philip Sloan
Institute for Medical Research Newcastle University Biosciences Institute
National Institutes of Health Newcastle University Centre for Cancer
Ministry of Health Newcastle upon Tyne, UK
Malaysia
Dr Max Robinson
Prof. Dr Peter Thomson Department of Cellular Pathology
Oral and Maxillofacial Surgery Newcastle University, UK.
Faculty of Dentistry
The University of Hong Kong Prof. Dr Edward Odell
Hong Kong, Hong Kong SAR King’s College London
Guy’s Hospital, London, UK
Deepa Nayar
King’s College London
Guy’s Hospital
London, UK

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