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

## TL;DR

This study shows that a risk-based screening and multidisciplinary approach improves early detection and outcomes for oral potentially malignant disorders.

## Contribution

A novel risk-stratified management model for OPMDs using a modified PVL scoring system and MDT collaboration is proposed and validated.

## Key findings

- High-risk OPMD patients had a 12.5% malignant transformation rate compared to 3.5% and 0% in intermediate and low-risk groups.
- Severe epithelial dysplasia, tongue/floor of mouth lesions, and betel quid use were independent risk factors for malignancy.
- The MDT model achieved 91.4% 2-year cancer-free survival in high-risk patients and 83.3% follow-up compliance.

## Abstract

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.

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.

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%.

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.