Malignant Transformation Rate of Oral Submucous Fibrosis: A Systematic Review and Meta-Analysis

Vignesh Murthy, Petros Mylonas, Barbara Carey, Sangeetha Yogarajah, Damian Farnell, Owen Addison, Richard Cook, Michael Escudier, Marcio Diniz-Freitas, Jacobo Limeres, Luis Monteiro, Luis Silva, Jean Cristophe Fricain, Sylvain Catros, Mathilde Fenelon, Giovanni Lodi, Niccolò Lombardi, Vlaho Brailo, Raj Ariyaratnam, José López-LópezRui Albuquerque*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)


Oral submucous fibrosis (OSF) is a chronic progressive condition affecting the oral cavity, oropharynx and upper third of the oesophagus. It is a potentially malignant disorder. The authors col-lated and analysed the existing literature to establish the overall malignant transformation rate (MTR). A retrospective analysis of medical and dental scientific literature using online indexed databases was conducted for the period 1956 to 2021. The quality of the enrolled studies was assessed by the Newcastle-Ottawa Scale (NOS). A meta-analysis using a random effects model of a single proportion was performed along with statistical tests for heterogeneity. The overall proportion of malignancy across all studies was 0.06 (95% CI, 0.02–0.10), indicating an overall 6% risk of malignant transformation across all studies and cohorts. Sub-group analyses revealed strong differences in proportion of malignancy according to ethnicity/cohort; Chinese = 0.02 (95% CI 0.01–0.02), Taiwanese = 0.06 (95% CI, 0.03–0.10), Indian = 0.08 (95% CI, 0.03–0.14) and Pakistani = 0.27 (95% CI 0.25–0.29). Overall, the MTR was 6%; however, wide heterogeneity of the included studies was noted. Geographic variations in MTR were noted but were not statistically significant. Further studies are required to analyse the difference between cohort groups.

Original languageEnglish
Article number1793
JournalJournal of Clinical Medicine
Issue number7
Early online date24 Mar 2022
Publication statusPublished - 1 Apr 2022


  • Areca nut
  • Betel nut
  • Malignant transformation rate
  • Oral cancer
  • Oral potentially malignant disorders
  • Oral squamous cell carcinoma
  • Oral submucous fibrosis


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