title: Differences in oral habit and lymphocyte subpopulation affect malignant transformation of patients with oral precancer.
abstract: OBJECTIVE
  In Taiwan, the combination of betel quid chewing, alcohol consumption, and smoking habits increases oral cancer risk by 123-fold compared to persons without these habits. Lymphocyte populations in patients may potentially affect the malignant transformation of oral precancer.
  
  
  METHODS
  A total of 28 patients with oral precancer from our previous cohort were enrolled in this study, and their personal information and oral habits were documented. Their lymphocyte populations (CD4+, CD8+, CD19+, and CD56+) and activation markers (CD25 and CD69) were determined by flow cytometry from 1999 to 2004. After follow up till December 2014, data of patients with/without malignant transformation were recorded, and the relation between oral habits and percentage of initial lymphocyte markers was evaluated using the Student t test and Fisher's exact test.
  
  
  RESULTS
  Ten precancer patients developed oral squamous cell carcinoma with a mean period of malignant transformation of 6.8 ± 2.1 years. Patients with malignant transformation had a mean age of 48.4 ± 5.0 years (n = 10), relatively more than that of patients without malignant transformation (41.6 ± 6.3 years, n = 18) (p < 0.05). An increase was noted in the population of peripheral blood mononuclear cells expressing CD4+CD69+, CD19+CD69+, and CD56+CD69+ (p < 0.05) in precancer patients with malignant transformation. Alcohol consumption showed an association with the malignant transformation of patients with precancer (p = 0.030), whereas betel quid and smoking showed little effect.
  
  
  CONCLUSIONS
  These results suggest that age, alcohol consumption, and early activation of T cells, B cells, and natural killer cells are crucial in the malignant transformation of oral precancer. Analysis of patient's lymphocyte populations may help predict the malignant transformation of oral precancer.
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chien-Yang
authors.initials: CY
authors.lastname: Yeh
authors.affiliation: Department of Dentistry, Mackay Memorial Hospital, Hsinchu, Taiwan.
authors.forename: Chien-Ling
authors.initials: CL
authors.lastname: Lin
authors.affiliation: Biomedical Science Team and Research Center for Industry of Human Ecology, Chang Gung University of Science and Technology, Kwei-Shan, Taoyuan, Taiwan; Chang Gung Memorial Hospital, Taiwan. Electronic address: mcchang@mail.cgust.edu.tw.
authors.forename: Mei-Chi
authors.initials: MC
authors.lastname: Chang
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hsin-Ming
authors.initials: HM
authors.lastname: Chen
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Seng-Heng
authors.initials: SH
authors.lastname: Kok
authors.affiliation: Biostatistic Laboratory, School of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Chang
authors.affiliation: Department of Dentistry, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors.forename: Ying-Shiung
authors.initials: YS
authors.lastname: Kuo
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Liang-Jiunn
authors.initials: LJ
authors.lastname: Hahn
authors.affiliation: Department of Dentistry, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Chiu-Po
authors.initials: CP
authors.lastname: Chan
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: leejj@ntuh.gov.tw.
authors.forename: Jang-Jaer
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: School of Dentistry and Department of Dentistry, National Taiwan University Medical College and National Taiwan University Hospital, Taipei, Taiwan. Electronic address: jhjeng@ntu.edu.tw.
authors.forename: Jiiang-Huei
authors.initials: JH
authors.lastname: Jeng
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D001114:Areca / Q000009:adverse effects*; D001402:B-Lymphocytes / Q000276:immunology; D015415:Biomarkers / Q000032:analysis; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology*; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D016131:Lymphocyte Subsets / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000453:epidemiology* / Q000209:etiology; D012907:Smoking / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: lymphocyte population; malignant transformation; oral cancer; oral habits