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May 26, 2026
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May 31, 2026
Published
June 23, 2026
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Abstract

frequently precede the development of oral squamous cell carcinoma (OSCC). Although tobacco use remains highly prevalent among Iraqi adult males, with smoking rates approaching 38%, there is a paucity of comprehensive data regarding the clinicopathological characteristics and biomarker expression profiles of OPMDs within the Iraqi population. Objective: This study aimed to characterize the clinicopathological features of OPMDs in Iraqi patients and to evaluate the diagnostic and predictive utility of five immunohistochemical (IHC) biomarkers—p53, Ki-67, CD44, E-cadherin, and vascular endothelial growth factor (VEGF)—in identifying high-grade epithelial dysplasia and malignant transformation. Methods: A prospective cross-sectional study was conducted at the College of Dentistry, University of Baghdad, between January 2022 and December 2024, involving 120 patients diagnosed with OPMDs. Histopathological grading was performed according to the 2022 World Health Organization (WHO) classification criteria. Immunohistochemical expression of the selected biomarkers was quantified using H-score methodology. Statistical analyses, including chi-square testing, one-way analysis of variance (ANOVA), multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis, were undertaken using SPSS version 26. Results: The mean patient age was 48.3 ± 11.2 years, with a male predominance (65%). Oral leukoplakia represented the most frequently diagnosed OPMD (45%). Erythroplakia demonstrated the highest cumulative frequency of moderate-to-severe dysplasia and OSCC (83.3%). Progressive increases in p53 expression were observed across the spectrum of dysplasia, rising from 22 ± 8 in non-dysplastic lesions to 215 ± 24 in OSCC cases. Similarly, Ki-67 expression increased from 14.8% to 74.6%, whereas E-cadherin expression exhibited a marked reduction from 248 ± 18 to 58 ± 18. Among individual biomarkers, p53 demonstrated the highest discriminatory performance for identifying high-grade lesions (AUC = 0.89; 95% CI: 0.83–0.95). Furthermore, a combined four-marker panel achieved excellent diagnostic accuracy with an AUC of 0.95. Conclusions: The findings of this study indicate that a focused immunohistochemical panel incorporating p53 and Ki-67 provides robust discriminatory capacity for the identification of high-grade OPMDs in the Iraqi clinical context. The integration of these biomarkers into routine diagnostic practice may facilitate earlier detection, improve risk stratification, and support timely therapeutic intervention, thereby potentially reducing the burden of OSCC in Iraq. 

Keywords

Cadherins Iraq Ki-67 Antigen Leukoplakia Oral Lichen Planus Oral MeSH Mouth Neoplasms Oral Submucous Fibrosis Tumor Suppressor Protein p53

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Copyright (c) 2026 Nadhema Bahaa Hussein, Nada Khazal, Riyam Naji Ali, Zainab Mohammadi, Ismael Mohammed Alsaadi (Author)

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Nadhema Bahaa Hussein (2026) “Malignant Transformation and Biomarker Expression in Oral Potentially Malignant Disorders: A Cross-Sectional Study in Iraqi Patients”, Future Dental Research, 4(1), pp. 16–26. doi:10.57238/fdr.2026.152576.1003.
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How to Cite

Nadhema Bahaa Hussein (2026) “Malignant Transformation and Biomarker Expression in Oral Potentially Malignant Disorders: A Cross-Sectional Study in Iraqi Patients”, Future Dental Research, 4(1), pp. 16–26. doi:10.57238/fdr.2026.152576.1003.

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