The management of oral leukoplakia (OL) is challenging because of a high risk for recurrence and malignant transformation (MT), and recurrent OL is associated with a higher risk of MT than nonrecurrent OL. The present meta-analysis aimed to examine the association between OL recurrence and surgical techniques used for their management as well as their clinicopathological factors. Electronic searches were conducted in EMBASE, PubMed, Scopus, and Web of Science to retrieve studies reporting OL recurrence after surgery. The pooled proportion of OL recurrence after surgical excision was estimated. Subgroup analyses were conducted based on the surgical technique, data type, grades of epithelial dysplasia, anatomical subsites, clinical type and size of the lesion, surgical margin, and risk habits. Meta-regression analyses were conducted to identify the association between age, sex, and follow-up duration and OL recurrence. The risk of MT based on the recurrence status was also estimated. A network meta-analysis was performed to determine the surgical modality associated with the least OL recurrence. Eighty studies with a total of 7,614 samples and various surgical modalities (laser-based techniques, conventional scalpel surgery, cryosurgery, and photodynamic therapy) were included in the meta-analysis. A pooled proportion of recurrence of 22% was observed. Laser-based surgeries resulted in fewer OL recurrences than other surgical modalities, and the combination of laser excision and vaporization was identified to be the best treatment approach. OL in the retromolar area and multiple sites, nonhomogeneous OL, advanced age, female sex, inadequate surgical margin, retrospective data, and betel quid chewing habit were significantly associated with higher OL recurrence. Recurrent OL showed a 7.39 times higher risk of MT than nonrecurrent OL. These results suggest that the combination of laser excision and vaporization might reduce OL recurrence. Furthermore, OL in older patients, females, and nonhomogeneous OL need close monitoring after any surgical therapy.

中文翻译：

---

口腔黏膜白细胞复发：系统评价和荟萃分析


口腔白斑病 （OL） 的管理具有挑战性，因为复发和恶性转化 （MT） 的风险很高，并且复发性 OL 比非复发性 OL 与 MT 风险更高相关。本荟萃分析旨在检查 OL 复发与用于其管理的手术技术之间的关联以及临床病理因素。在 EMBASE、PubMed、Scopus 和 Web of Science 中进行电子检索，以检索报告术后 OL 复发的研究。估计手术切除后 OL 复发的合并比例。根据手术技术、数据类型、上皮发育不良分级、解剖亚位点、病灶临床类型和大小、手术切缘和风险习惯进行亚组分析。进行 Meta 回归分析以确定年龄、性别和随访持续时间与 OL 复发之间的相关性。还根据复发状态估计了 MT 的风险。进行网状荟萃分析以确定与 OL 复发最少相关的手术方式。荟萃分析纳入了 80 项研究，共 7,614 个样本和各种手术方式（基于激光的技术、常规手术刀手术、冷冻手术和光动力疗法）。观察到 22% 的复发率。与其他手术方式相比，基于激光的手术导致更少的 OL 复发，激光切除和汽化相结合被确定为最佳治疗方法。磨牙后区和多个部位的 OL、非均匀的 OL、高龄、女性、手术切缘不足、回顾性资料和槟榔咀嚼习惯与较高的 OL 复发率显著相关。 复发性 OL 显示 MT 风险比非复发性 OL 高 7.39 倍。这些结果表明，激光切除和汽化相结合可能会减少 OL 复发。此外，老年患者、女性和非均质性 OL 在任何手术治疗后都需要密切监测 OL。