Clinical practice of early screening and risk-stratified management for oral potentially malignant disorders

Abstract

Objective: To evaluate the application value of standardized screening and risk-stratified management in the clinical practice of Oral Potentially Malignant Disorders (OPMDs) for improving early diagnosis rates and optimizing intervention strategies. Methods: A total of 312 OPMD patients diagnosed between January 2017 and December 2022 were enrolled. A screening pathway of “initial screening (questionnaire + visual/tactile examination) - refined screening (pathological biopsy)” was established. Risk stratification (low, intermediate, high) was performed using a modified Proliferative Verrucous Leukoplakia (PVL)-based scoring system. Multidisciplinary team (MDT) management was implemented. Risk factors for malignant transformation were analyzed using Cox regression. Results: The high-risk group had a significantly higher malignant transformation rate than the intermediate and low-risk groups (12.5% vs. 3.5% vs. 0%, P<0.001), with a shorter median time to transformation (23.4 months). Severe epithelial dysplasia (HR = 6.24), lesions located in the tongue ventral/floor of mouth (HR = 3.34), and betel quid chewing history (HR = 2.62) were identified as independent risk factors. The MDT model achieved a 2-year cancer-free survival rate of 91.4% in high-risk patients and improved follow-up compliance to 83.3%. Conclusion: An OPMD management model based on risk stratification and MDT collaboration can effectively identify high-risk patients, optimize intervention timing, and improve prognosis. This model is suitable for promotion in primary care hospitals.