Malignant Transformation Risk in Patients With Oral Leukoplakia and Type 2 Diabetes Mellitus

Area of Science:

• Oral Medicine
• Endocrinology
• Oncology

Background:

• Oral leukoplakia (OLK) is the most common potentially malignant oral disorder, with malignant transformation rates up to 9.8%.
• Type 2 diabetes mellitus (T2DM) is linked to increased cancer risk, but specific risk factors for malignant transformation in OLK-T2DM patients are undefined.

Purpose of the Study:

• To identify risk factors for malignant transformation in OLK patients with T2DM.
• To develop predictive models integrating glycaemic and clinical indicators for malignant transformation risk.

Main Methods:

• A retrospective nested case-control study of an OLK-T2DM cohort (2013-2025).
• Cases (n=55) with malignant transformation were matched 1:2 with controls (n=110).
• Glycaemic control (FPG, HbA1c) and oral epithelial dysplasia were analyzed using regression and machine learning models.

Main Results:

• Suboptimal glycaemic control (HbA1c > 7% or FPG > 7.2 mmol/L) was strongly associated with malignant transformation.
• Each 1 mmol/L increase in FPG increased malignant transformation risk by 60-174%.
• Moderate/severe dysplasia (aHR=399.43) and suboptimal glycaemia were independent predictors; machine learning models achieved AUC up to 0.78.

Conclusions:

• Suboptimal glycaemic control is an independent risk factor for malignant transformation in OLK-T2DM patients.
• Integrating glycaemic indicators into risk prediction tools can improve identification of high-risk individuals.
• Emphasizes the importance of early monitoring and strict glycaemic management in OLK-T2DM patients.