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Background <p>Oral potentially malignant disorders (OPMDs) represent a significant oncological challenge in South Asia. While the carcinogenicity of areca nut and tobacco is well-established, the factors driving extreme clinical severity in certain cohorts remain incompletely quantified. This retrospective pilot study evaluates the synergistic impact of local and systemic co-factors on OPMD severity in a Western Indian population.</p> Methods <p>A retrospective pilot analysis of 210 clinical records (January 2022–December 2024) was conducted at a tertiary care institute in Western India. Oral Submucous Fibrosis (OSMF) was staged using the Khanna and Andrade classification. Multivariable logistic regression, validated by the Hosmer-Lemeshow test (p = 0.72) and receiver operating characteristic analysis (AUC: 0.84; 95% CI: 0.78–0.90), was used to estimate adjusted odds ratios (aOR) for advanced disease (OSMF Group III/IV or non-homogeneous leukoplakia), controlling for age and sex. Residual confounding from habit duration and socioeconomic status is acknowledged as a study limitation.</p> Results <p>Advanced OSMF (Group III/IV) was observed in 56 of 114 OSMF patients (49.1% of the OSMF sub-cohort). The convergence of four or more risk factors (carcinogenic habits, poor oral hygiene, undernutrition, and dietary irritation) was associated with markedly elevated odds of advanced disease (aOR: 8.3; 95% CI: 4.2–16.4; p &lt; 0.001). The combination of undernutrition and anaemia independently demonstrated a strong synergistic effect (aOR: 5.8; 95% CI: 2.9–11.6; p &lt; 0.001). Model validation confirmed robust performance: Hosmer-Lemeshow p = 0.72, mean VIF = 1.26, and AUC = 0.84</p> Conclusion <p>Clinical severity of OPMDs in Western India is driven by a multifactorial synergistic model. Management strategies must extend beyond habit cessation to integrate periodontal care and nutritional rehabilitation. Prospective validation incorporating structured habit-duration data and salivary biomarker analysis is required.</p>

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Synergistic Risk Factors and Clinical Severity of Oral Potentially Malignant Disorders in Western India: A Retrospective Pilot Study

  • 期刊论文

  • 发表日期：

    2026年4月20日

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  • Chandrashekhar Chattopadhyay,
  • Vikas Deo,
  • Mamta Patel,
  • Charu Chouhan,
  • Priti Airun,
  • Sugandha Jain,
  • Ayush Garg

摘要

Background

Oral potentially malignant disorders (OPMDs) represent a significant oncological challenge in South Asia. While the carcinogenicity of areca nut and tobacco is well-established, the factors driving extreme clinical severity in certain cohorts remain incompletely quantified. This retrospective pilot study evaluates the synergistic impact of local and systemic co-factors on OPMD severity in a Western Indian population.

Methods

A retrospective pilot analysis of 210 clinical records (January 2022–December 2024) was conducted at a tertiary care institute in Western India. Oral Submucous Fibrosis (OSMF) was staged using the Khanna and Andrade classification. Multivariable logistic regression, validated by the Hosmer-Lemeshow test (p = 0.72) and receiver operating characteristic analysis (AUC: 0.84; 95% CI: 0.78–0.90), was used to estimate adjusted odds ratios (aOR) for advanced disease (OSMF Group III/IV or non-homogeneous leukoplakia), controlling for age and sex. Residual confounding from habit duration and socioeconomic status is acknowledged as a study limitation.

Results

Advanced OSMF (Group III/IV) was observed in 56 of 114 OSMF patients (49.1% of the OSMF sub-cohort). The convergence of four or more risk factors (carcinogenic habits, poor oral hygiene, undernutrition, and dietary irritation) was associated with markedly elevated odds of advanced disease (aOR: 8.3; 95% CI: 4.2–16.4; p < 0.001). The combination of undernutrition and anaemia independently demonstrated a strong synergistic effect (aOR: 5.8; 95% CI: 2.9–11.6; p < 0.001). Model validation confirmed robust performance: Hosmer-Lemeshow p = 0.72, mean VIF = 1.26, and AUC = 0.84

Conclusion

Clinical severity of OPMDs in Western India is driven by a multifactorial synergistic model. Management strategies must extend beyond habit cessation to integrate periodontal care and nutritional rehabilitation. Prospective validation incorporating structured habit-duration data and salivary biomarker analysis is required.