{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T21:16:20Z","timestamp":1790198180369,"version":"4.1.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004484","name":"Tehran University of Medical Sciences and Health Services","doi-asserted-by":"publisher","award":["1401- 3-133-62165"],"award-info":[{"award-number":["1401- 3-133-62165"]}],"id":[{"id":"10.13039\/501100004484","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Oral epithelial dysplasia (OED) is a premalignant condition with a variable risk of malignant transformation (MT). This study investigates the recurrence and MT rates in an Iranian patient cohort with OED, evaluating associations with demographic factors, lifestyle habits, and histopathologic grading systems, with the aim of providing population-specific prognostic insights and enhancing disease prediction and patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This mixed cohort study included 89 surgically treated patients with OED, followed for 24\u2013168 months. Demographic data, smoking and alcohol consumption history, recurrence, and MT status were collected from medical records. Histopathological grading was performed using both the WHO 2017 classification and a binary grading system. Kaplan-Meier survival analysis, Cox regression, and statistical tests were applied to identify prognostic factors. A p-value &lt;0.05 was considered statistically significant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During follow-up, 22.5% (20\/89) of patients experienced recurrence, and 30.3% (27\/89) underwent MT. The tongue was the most common site for OED (48.3%), recurrence (55%), and MT (44.4%). Males were more frequently affected than females (60.7% vs. 39.3%,), but females tended to remain cancer-free more often. Smoking and alcohol consumption did not significantly influence cancer development.<\/jats:p>\n                    <jats:p>Kaplan-Meier analysis showed 50% of MT cases occurred after about 108 months (mean: 114.8 months). The combined mean survival for recurrence and MT was 92.8 months. Cox regression identified WHO grading as the only statistically significant predictor of MT and recurrence\/MT (p\u2009=\u20090.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The WHO grading system plays a crucial role in predicting the likelihood of OED recurrence and malignant transformation. Lesion location showed only a non-significant trend, suggesting that its effect may be mediated by grade. These findings highlight the importance of using grading-based risk assessments and ensuring close follow-up care to better manage OED and improve patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0337402","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T18:33:15Z","timestamp":1766169195000},"page":"e0337402","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic factors for recurrence and malignant transformation after treatment of oral epithelial dysplasia: A mixed cohort study"],"prefix":"10.1371","volume":"20","author":[{"given":"Zohreh","family":"Moradipour","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Derakhshan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4170-9596","authenticated-orcid":true,"given":"Monir","family":"Moradzadeh Khiavi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafiseh","family":"Sheikhbahaei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Javad","family":"Kharazifard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,19]]},"reference":[{"issue":"3","key":"pone.0337402.ref001","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1111\/j.1600-0714.2007.00584.x","article-title":"Oral epithelial dysplasia classification systems: predictive value, utility, weaknesses and scope for improvement","volume":"37","author":"S Warnakulasuriya","year":"2008","journal-title":"J Oral Pathol Med"},{"issue":"6","key":"pone.0337402.ref002","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1111\/j.1600-0714.2009.00782.x","article-title":"Outcome of oral dysplasia: a retrospective hospital-based study of 207 patients with a long follow-up","volume":"38","author":"PG Arduino","year":"2009","journal-title":"J Oral Pathol Med"},{"issue":"2","key":"pone.0337402.ref003","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1111\/odi.12007","article-title":"Treatment results of CO2 laser vaporisation in a cohort of 35 patients with oral leukoplakia","volume":"19","author":"EREA Brouns","year":"2013","journal-title":"Oral Dis"},{"issue":"6","key":"pone.0337402.ref004","article-title":"Treatment outcome of dysplastic oral leukoplakia with carbon dioxide laser--emphasis on the factors affecting recurrence","volume":"69","author":"S-W Yang","year":"2011","journal-title":"J Oral Maxillofac Surg"},{"issue":"1","key":"pone.0337402.ref005","doi-asserted-by":"crossref","first-page":"15611","DOI":"10.1038\/s41598-025-98096-8","article-title":"Prevalence and determinants of oral potentially malignant disorders in western rajasthan","volume":"15","author":"JK Gautam","year":"2025","journal-title":"Sci Rep"},{"issue":"3","key":"pone.0337402.ref006","doi-asserted-by":"crossref","first-page":"773","DOI":"10.4103\/jcrt.jcrt_1151_21","article-title":"Prevalence and determinants of oral potentially malignant disorders in rural areas of South India","volume":"19","author":"C Jose","year":"2023","journal-title":"J Cancer Res Ther"},{"issue":"1","key":"pone.0337402.ref007","doi-asserted-by":"crossref","first-page":"5232","DOI":"10.1038\/s41598-024-54410-4","article-title":"Prevalence and risk factors of oral potentially malignant disorders in Indonesia: a cross-sectional study undertaken in 5 provinces","volume":"14","author":"EF Sari","year":"2024","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0337402.ref008","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1186\/s12903-024-04554-6","article-title":"A study of risk factors associated with the presence of oral potentially malignant disorders: a community-based study from Northeastern Thailand","volume":"24","author":"P Chiewwit","year":"2024","journal-title":"BMC Oral Health"},{"issue":"3","key":"pone.0337402.ref009","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/jop.12339","article-title":"Malignant transformation of oral leukoplakia: a systematic review of observational studies","volume":"45","author":"S Warnakulasuriya","year":"2016","journal-title":"J Oral Pathol Med"},{"issue":"3","key":"pone.0337402.ref010","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1002\/hed.26006","article-title":"Potentially malignant disorders of the oral cavity and oral dysplasia: A systematic review and meta-analysis of malignant transformation rate by subtype","volume":"42","author":"O Iocca","year":"2020","journal-title":"Head Neck"},{"issue":"1","key":"pone.0337402.ref011","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s10147-010-0169-z","article-title":"Oral premalignant lesions: from the pathological viewpoint","volume":"16","author":"T Izumo","year":"2011","journal-title":"Int J Clin Oncol"},{"issue":"2","key":"pone.0337402.ref012","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s12070-011-0347-y","article-title":"Oral dermatological conditions: a clinical study","volume":"65","author":"S Roy","year":"2013","journal-title":"Indian J Otolaryngol Head Neck Surg"},{"issue":"1","key":"pone.0337402.ref013","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/2347-8128.182853","article-title":"A clinicopathological study of oral potentially malignant disorders","volume":"4","author":"S Hosagadde","year":"2016","journal-title":"Journal of Head & Neck Physicians and Surgeons"},{"issue":"1","key":"pone.0337402.ref014","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jds.2020.04.003","article-title":"Long-term follow-up of oral epithelial dysplasia: A hospital based cross-sectional study","volume":"16","author":"MA Jaber","year":"2021","journal-title":"J Dent Sci"},{"key":"pone.0337402.ref015","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1186\/1471-2407-9-260","article-title":"Malignant transformation of oral potentially malignant disorders in males: a retrospective cohort study","volume":"9","author":"P-S Ho","year":"2009","journal-title":"BMC Cancer"},{"issue":"3","key":"pone.0337402.ref016","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/S1079-2104(05)80226-4","article-title":"Oral epithelial dysplasia and the development of invasive squamous cell carcinoma","volume":"79","author":"H Lumerman","year":"1995","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol Endod"},{"issue":"1","key":"pone.0337402.ref017","first-page":"854636","article-title":"Malignant transformation rate in patients presenting oral epithelial dysplasia: systematic review and meta\u2010analysis","volume":"2015","author":"JA Shariff","year":"2015","journal-title":"Journal of Oral Diseases"},{"issue":"7","key":"pone.0337402.ref018","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1111\/jop.12726","article-title":"Prevalence of oral potentially malignant disorders: A systematic review and meta-analysis","volume":"47","author":"FW Mello","year":"2018","journal-title":"J Oral Pathol Med"},{"issue":"3","key":"pone.0337402.ref019","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.oooo.2013.09.017","article-title":"Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading","volume":"117","author":"F Dost","year":"2014","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"1","key":"pone.0337402.ref020","doi-asserted-by":"crossref","first-page":"8261","DOI":"10.1038\/s41598-022-12441-9","article-title":"Malignant transformation of oral epithelial dysplasia in Southwest Finland","volume":"12","author":"TT Nevanp\u00e4\u00e4","year":"2022","journal-title":"Sci Rep"},{"issue":"12","key":"pone.0337402.ref021","doi-asserted-by":"crossref","first-page":"3096","DOI":"10.1002\/hed.27539","article-title":"Clinical outcomes of oral epithelial dysplasia managed by observation versus excision","volume":"45","author":"C Bernard","year":"2023","journal-title":"Head Neck"},{"issue":"8","key":"pone.0337402.ref022","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1016\/j.joms.2023.04.017","article-title":"American Association of Oral and Maxillofacial Surgeon\u2019s Position Paper on Oral Mucosal Dysplasia","volume":"81","author":"ER Carlson","year":"2023","journal-title":"J Oral Maxillofac Surg"},{"issue":"9","key":"pone.0337402.ref023","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1038\/s41379-022-01067-x","article-title":"Prediction of malignant transformation and recurrence of oral epithelial dysplasia using architectural and cytological feature specific prognostic models","volume":"35","author":"H Mahmood","year":"2022","journal-title":"Mod Pathol"},{"issue":"12","key":"pone.0337402.ref024","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1002\/hed.21131","article-title":"Treatment and follow-up of oral dysplasia - a systematic review and meta-analysis","volume":"31","author":"HM Mehanna","year":"2009","journal-title":"Head Neck"},{"issue":"12","key":"pone.0337402.ref025","doi-asserted-by":"crossref","first-page":"4563","DOI":"10.1007\/s00784-020-03322-4","article-title":"Malignant transformation of oral leukoplakia: a follow-up study","volume":"24","author":"PR Jayasooriya","year":"2020","journal-title":"Clin Oral Investig"},{"issue":"3","key":"pone.0337402.ref026","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.oooo.2013.09.017","article-title":"Malignant transformation of oral epithelial dysplasia: a real-world evaluation of histopathologic grading","volume":"117","author":"F Dost","year":"2014","journal-title":"Oral Surg Oral Med Oral Pathol Oral Radiol"},{"issue":"2","key":"pone.0337402.ref027","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/S1368-8375(98)00106-7","article-title":"Risk factors for oral epithelial dysplasia--the role of smoking and alcohol","volume":"35","author":"MA Jaber","year":"1999","journal-title":"Oral Oncol"},{"issue":"1","key":"pone.0337402.ref028","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/0030-4220(85)90215-4","article-title":"A study of the clinical characteristics and treatment of oral carcinoma in situ","volume":"60","author":"T Amagasa","year":"1985","journal-title":"Oral Surg Oral Med Oral Pathol"},{"key":"pone.0337402.ref029"},{"issue":"2","key":"pone.0337402.ref030","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s10006-012-0317-x","article-title":"Oral field cancerization: current evidence and future perspectives","volume":"16","author":"PV Angadi","year":"2012","journal-title":"Oral Maxillofac Surg"},{"issue":"7","key":"pone.0337402.ref031","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.oraloncology.2015.04.006","article-title":"Cancer stem cells and field cancerization of oral squamous cell carcinoma","volume":"51","author":"M Simple","year":"2015","journal-title":"Oral Oncol"},{"key":"pone.0337402.ref032","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.oraloncology.2017.03.018","article-title":"Investigating a case of possible field cancerization in oral squamous cell carcinoma by the use of next-generation sequencing","volume":"68","author":"S Tabatabaeifar","year":"2017","journal-title":"Oral Oncol"},{"issue":"1","key":"pone.0337402.ref033","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/prd.12259","article-title":"Oral epithelial dysplasia: Causes, quantification, prognosis, and management challenges","volume":"80","author":"WM Tilakaratne","year":"2019","journal-title":"Periodontol 2000"},{"issue":"8","key":"pone.0337402.ref034","first-page":"1110","article-title":"Malignant Transformation in Leukoplakia and Its Associated Factors in Southern Iran: A Hospital Based Experience","volume":"46","author":"A Barfi Qasrdashti","year":"2017","journal-title":"Iran J Public Health"},{"issue":"10","key":"pone.0337402.ref035","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1016\/j.oraloncology.2005.12.014","article-title":"Evaluation of a new binary system of grading oral epithelial dysplasia for prediction of malignant transformation","volume":"42","author":"O Kujan","year":"2006","journal-title":"Oral Oncol"},{"issue":"4","key":"pone.0337402.ref036","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1097\/PAP.0000000000000343","article-title":"Oral Epithelial Dysplasia: A Review of Diagnostic Criteria for Anatomic Pathologists","volume":"29","author":"VKY Cheung","year":"2022","journal-title":"Adv Anat Pathol"},{"key":"pone.0337402.ref037","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/1758-3284-1-11","article-title":"Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility","volume":"1","author":"S Fleskens","year":"2009","journal-title":"Head Neck Oncol"},{"issue":"2","key":"pone.0337402.ref038","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1002\/1096-9896(200106)194:2<143::AID-PATH883>3.0.CO;2-Z","article-title":"Dysplasia classification: pathology in disgrace?","volume":"194","author":"FT Bosman","year":"2001","journal-title":"J Pathol"},{"issue":"3","key":"pone.0337402.ref039","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1002\/1097-0142(19840201)53:3<563::AID-CNCR2820530332>3.0.CO;2-F","article-title":"Oral leukoplakia and malignant transformation. A follow-up study of 257 patients","volume":"53","author":"Jr Silverman S","year":"1984","journal-title":"Cancer"},{"key":"pone.0337402.ref040","doi-asserted-by":"crossref","first-page":"105462","DOI":"10.1016\/j.oraloncology.2021.105462","article-title":"Recurrence and malignant transformation rates of high grade oral epithelial dysplasia over a 10 year follow up period and the influence of surgical intervention, size of excision biopsy and marginal clearance in a UK regional maxillofacial surgery unit","volume":"121","author":"C Gilvetti","year":"2021","journal-title":"Oral Oncol"},{"key":"pone.0337402.ref041","doi-asserted-by":"crossref","first-page":"886404","DOI":"10.3389\/fonc.2022.886404","article-title":"Clinical and Histological Prognostic Factors of Recurrence and Malignant Transformation in a Large Series of Oral Potentially Malignant Disorders","volume":"12","author":"L Lorini","year":"2022","journal-title":"Front Oncol"},{"key":"pone.0337402.ref042"},{"issue":"1","key":"pone.0337402.ref043","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/j.1600-0714.2006.00491.x","article-title":"Malignant transformation in 1458 patients with potentially malignant oral mucosal disorders: a follow-up study based in a Taiwanese hospital","volume":"36","author":"S-S Hsue","year":"2007","journal-title":"J Oral Pathol Med"},{"issue":"1","key":"pone.0337402.ref044","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4103\/jomfp.JOMFP_347_19","article-title":"Prevalence of oral cancer and oral epithelial dysplasia among North Indian population: A retrospective institutional study","volume":"24","author":"S Singh","year":"2020","journal-title":"J Oral Maxillofac Pathol"},{"issue":"1","key":"pone.0337402.ref045","article-title":"Oral potentially malignant disorders: clinical-pathological study of 684 cases diagnosed in a Brazilian population","volume":"25","author":"FR Pires","year":"2020","journal-title":"Med Oral Patol Oral Cir Bucal"},{"issue":"6","key":"pone.0337402.ref046","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/S1368-8375(03)00045-9","article-title":"Oral epithelial dysplasia: clinical characteristics of western European residents","volume":"39","author":"MA Jaber","year":"2003","journal-title":"Oral Oncol"},{"issue":"3","key":"pone.0337402.ref047","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/0030-4220(72)90468-9","article-title":"Observations on the clinical characteristics of oral lesions showing histologic epithelial dysplasia","volume":"33","author":"HH Mincer","year":"1972","journal-title":"Oral Surg Oral Med Oral Pathol"},{"issue":"6","key":"pone.0337402.ref048","doi-asserted-by":"crossref","first-page":"523","DOI":"10.1111\/odi.12484","article-title":"A comparative study using WHO and binary oral epithelial dysplasia grading systems in actinic cheilitis","volume":"22","author":"PR C\u00e2mara","year":"2016","journal-title":"Oral Dis"},{"issue":"8","key":"pone.0337402.ref049","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1111\/odi.13993","article-title":"Oral epithelial dysplasia: Recognition, grading and clinical significance","volume":"27","author":"E Odell","year":"2021","journal-title":"Oral Dis"},{"issue":"7","key":"pone.0337402.ref050","doi-asserted-by":"crossref","first-page":"4329","DOI":"10.1007\/s00784-021-04008-1","article-title":"Binary and WHO dysplasia grading systems for the prediction of malignant transformation of oral leukoplakia and erythroplakia: a systematic review and meta-analysis","volume":"25","author":"BS de Freitas Silva","year":"2021","journal-title":"Clin Oral Investig"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337402","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T18:33:24Z","timestamp":1766169204000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0337402"}},"subtitle":[],"editor":[{"given":"John","family":"Adeoye","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":50,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0337402","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]}}}