Alcohol and the Risk of Recurrence Following Oral Precancer Treatment

OBJECTIVES: Predicting recurrent disease following oral precancer treatment remains problematic. Whilst smoking is a well known risk factor, the role of alcohol in oral precancerous lesion (OPL) recurrence is unclear. It is believed that patients' self reported alcohol behaviour is unreliable. Objective measures of alcohol intake, such as raised mean red cell volume (MCV) or increased alanine transaminase (ALT)levels, may thus be of more use as predictive agents. The aim of this study was to compare subjective (patient report) and objective (MCV & ALT) measures of alcohol intake at oral precancer presentation and at 2 years post lesion excision.

METHODS: Following ethical approval, 54 patients with dysplastic OPLs were recruited into the study. All patients were smokers (10-20/day)and all underwent an interventional management protocol comprising risk factor identification and laser excision of OPLs. Patients subjectively reported alcohol intake by means of a structured questionnaire, whilst pre-operative venous blood samples were analysed for MCV & ALT. Clinical outcome 2 years post surgery was determined and statistical comparisons carried out using non-parametric analyses.

RESULTS: A significant relationship was seen between subjective (patient report) heavy alcohol intake (>28 units/week)and recurrent OPL 2 years post-surgery (p=0.012). No significant relationship was seen, however, between either MCV or ALT at disease presentation and clinical outcome at 2 years.

CONCLUSIONS: Patients' reported alcohol intake at initial oral precancer presentation appears an accurate predictor of disease recurrence, whilst MCV & ALT were non-predictive in this study.