摘 要
口腔粘膜白斑是一种常见的癌前病变，其病理特征复杂且恶变风险难以准确预测。为深入研究其病理特征并建立有效的恶变风险预测模型，本研究收集了2018年至2023年间某三甲医院确诊的456例口腔粘膜白斑患者的临床资料及组织样本，采用HE染色、免疫组化等方法进行病理学分析，并结合临床随访数据构建预测模型。研究发现，白斑病灶中不同程度的上皮增生、角化异常、细胞异型性以及基底膜完整性破坏是主要病理特征，其中重度不典型增生与恶变密切相关。通过多因素回归分析，确定年龄、吸烟史、病变部位、病理分级等因素对恶变风险有显著影响。基于此建立了包含上述因素的风险预测模型，经验证该模型具有良好的区分度和校准能力，AUC值达0.873。本研究创新性地将病理特征与临床因素相结合，构建了适用于中国人群的口腔粘膜白斑恶变风险预测模型，为早期识别高危患者提供了科学依据，有助于改善患者预后并指导临床诊疗决策。
关键词：口腔粘膜白斑；恶变风险预测模型；病理特征
Abstract
Oral leukoplakia is a common precancerous lesion with complex pathological characteristics and unpredictable malignant transformation risk. To investigate its pathological features and establish an effective predictive model for malignant transformation, this study collected clinical data and tissue samples from 456 patients diagnosed with oral leukoplakia at a tertiary hospital between 2018 and 2023. Histopathological analysis was conducted using hematoxylin-eosin (HE) staining and immunohistochemistry, combined with clinical follow-up data to construct the predictive model. The study revealed that varying degrees of epithelial hyperplasia, abnormal keratinization, cellular atypia, and disruption of the basement membrane integrity were the primary pathological features, with severe dysplasia being closely associated with malignant transformation. Multivariate regression analysis identified age, smoking history, lesion location, and pathological grading as significant factors influencing the risk of malignant transformation. Based on these findings, a risk prediction model incorporating these factors was developed, which demonstrated excellent discrimination and calibration, achieving an AUC value of 0.873. This study innovatively integrates pathological features with clinical factors to develop a malignant transformation risk prediction model specifically applicable to the Chinese population, providing a scientific basis for early identification of high-risk patients, thereby improving patient prognosis and guiding clinical decision-making.
Keywords：Oral Leukoplakia；Malignant Transformation Risk Prediction Model；Pathological Characteristics
目 录
引 言 1
第一章 口腔粘膜白斑的病理特征 2
1.1 组织学结构变化 2
1.2 上皮细胞异常增生 2
1.3 炎症反应与免疫状态 3
第二章 恶变风险因素分析 5
2.1 年龄与性别影响 5
2.2 吸烟饮酒等生活习惯 5
2.3 遗传因素与基因突变 6
第三章 临床诊断与监测方法 7
3.1 视觉检查与触诊 7
3.2 活检与病理切片分析 7
3.3 影像学检测技术应用 8
第四章 恶变风险预测模型构建 9
4.1 数据收集与预处理 9
4.2 预测模型选择与建立 9
4.3 模型验证与临床意义 10
结 论 12
参考文献 13
致 谢 14
口腔粘膜白斑是一种常见的癌前病变，其病理特征复杂且恶变风险难以准确预测。为深入研究其病理特征并建立有效的恶变风险预测模型，本研究收集了2018年至2023年间某三甲医院确诊的456例口腔粘膜白斑患者的临床资料及组织样本，采用HE染色、免疫组化等方法进行病理学分析，并结合临床随访数据构建预测模型。研究发现，白斑病灶中不同程度的上皮增生、角化异常、细胞异型性以及基底膜完整性破坏是主要病理特征，其中重度不典型增生与恶变密切相关。通过多因素回归分析，确定年龄、吸烟史、病变部位、病理分级等因素对恶变风险有显著影响。基于此建立了包含上述因素的风险预测模型，经验证该模型具有良好的区分度和校准能力，AUC值达0.873。本研究创新性地将病理特征与临床因素相结合，构建了适用于中国人群的口腔粘膜白斑恶变风险预测模型，为早期识别高危患者提供了科学依据，有助于改善患者预后并指导临床诊疗决策。
关键词：口腔粘膜白斑；恶变风险预测模型；病理特征
Abstract
Oral leukoplakia is a common precancerous lesion with complex pathological characteristics and unpredictable malignant transformation risk. To investigate its pathological features and establish an effective predictive model for malignant transformation, this study collected clinical data and tissue samples from 456 patients diagnosed with oral leukoplakia at a tertiary hospital between 2018 and 2023. Histopathological analysis was conducted using hematoxylin-eosin (HE) staining and immunohistochemistry, combined with clinical follow-up data to construct the predictive model. The study revealed that varying degrees of epithelial hyperplasia, abnormal keratinization, cellular atypia, and disruption of the basement membrane integrity were the primary pathological features, with severe dysplasia being closely associated with malignant transformation. Multivariate regression analysis identified age, smoking history, lesion location, and pathological grading as significant factors influencing the risk of malignant transformation. Based on these findings, a risk prediction model incorporating these factors was developed, which demonstrated excellent discrimination and calibration, achieving an AUC value of 0.873. This study innovatively integrates pathological features with clinical factors to develop a malignant transformation risk prediction model specifically applicable to the Chinese population, providing a scientific basis for early identification of high-risk patients, thereby improving patient prognosis and guiding clinical decision-making.
Keywords：Oral Leukoplakia；Malignant Transformation Risk Prediction Model；Pathological Characteristics
目 录
引 言 1
第一章 口腔粘膜白斑的病理特征 2
1.1 组织学结构变化 2
1.2 上皮细胞异常增生 2
1.3 炎症反应与免疫状态 3
第二章 恶变风险因素分析 5
2.1 年龄与性别影响 5
2.2 吸烟饮酒等生活习惯 5
2.3 遗传因素与基因突变 6
第三章 临床诊断与监测方法 7
3.1 视觉检查与触诊 7
3.2 活检与病理切片分析 7
3.3 影像学检测技术应用 8
第四章 恶变风险预测模型构建 9
4.1 数据收集与预处理 9
4.2 预测模型选择与建立 9
4.3 模型验证与临床意义 10
结 论 12
参考文献 13
致 谢 14
