研究背景：自2010年起，口腔黏膜檢查正式納入我國四癌公費篩檢之一，針對具菸檳習慣之高風險族群，會藉由專業醫師進行視診，以早期發現口腔異常與口腔癌前病變(Oral Potentially Malignant Disorders, OPMD)。雖然篩檢制度已行之有年，然而目前相關研究多聚焦於篩檢本身的成效，較少探討OPMD確診後個案的癌轉風險，亦缺乏對其後續追蹤與治療歷程的探討。
研究目的：本研究以經口腔黏膜篩檢首次確診為OPMD之個案為對象，進行後續就醫類型與病程發展的觀察與分析。研究目的包括：描述經篩檢首次確診OPMD之類型分布；分析確診後一年內即惡性轉化為口腔癌之情形；探討確診一年內的就醫與治療行為；評估確診一年後之癌轉風險及其影響因素；並進一步描述個案於長期追蹤期間的就醫與再次接受篩檢之情形。
研究方法：本研究為世代研究，資料來源為我國口腔癌篩檢檔，並納入2011年初至2019年中確診為OPMD的個案，並以確診日起進行追蹤。藉由串聯全民健保門急診檔，以取得個案的醫療與手術紀錄，掌握其確診後的醫療利用情形；同時結合癌症登記檔與死因檔，以釐清其後續口腔癌發生與死亡狀況。同時進一步分析個案的癌轉風險與後續就醫、治療與追蹤行為。研究內容包括以下五點。第一、描述經篩檢首次確診OPMD之類型分布，呈現不同病變類型之人數與占比。第二、分析OPMD確診後一年內即惡性轉化為口腔癌之情形，探討各類型之短期癌轉風險差異。接著，排除上述確診一年內即發生口腔癌或死亡事件之個案後，進入以下分析：第三、評估確診後一年內之就醫與治療行為，檢視初期醫療介入狀況在不同變項間的差異。第四、針對確診一年後的癌轉風險，進行長期追蹤分析，以瞭解個案在經歷初期觀察期後的惡性轉化情形，此部分將計算每千人年之癌轉率，並使用Kaplan-Meier生存曲線檢視各變項之累積癌轉情形，進一步以Cox比例風險模型評估人口學特徵與其他變項對癌轉風險之影響。最後，呈現OPMD個案於確診後總計六年間的長期就醫、再次篩檢、癌轉與死亡之完整追蹤歷程。
研究結果：類型分布方面，「均質性薄白斑」為最常見之診斷類型，其次為「黏膜下纖維化」，兩者合計占比超過七成，顯示病變分布具有明顯集中性。癌轉方面，以「疣狀增生」的惡性轉化率最高，達12.26，調整後風險比(HRs)為4.69，各項指標皆顯示其具有顯著的癌化潛勢。相較之下，「均質性薄白斑」的轉化風險僅為2.10，顯示其預後相對穩定，屬於癌轉風險較低的病變類型。就醫類型則揭示「均質性薄白斑」與「黏膜下纖維化」於確診後一年內之就醫率僅為7%，顯著低於其他OPMD類型(多數介於20%至30%之間)，可能反映此二類病灶症狀較不明顯、警示性不足，或個案對疾病嚴重性之認知有限。此外，黏膜下纖維化之每千人年癌轉率為8.26，為所有類型的第二高；Cox比例風險模型更顯示其惡性轉化風險比(HRs)達3.83。上述結果皆指出其該類型具有顯著較高之癌化風險，與目前政府處置準則中將其歸類為低風險病變之認定有所出入。於長達六年之追蹤期間觀察個案醫療行為變化後發現，「無作為(No action)」為各區段最主要之狀態，顯示多數個案未接受篩檢、就醫或手術介入；「篩檢(Screen only」)之比例則呈現先上升後下降之趨勢。進一步依病變類型分層後可見，也僅有確診初期之就醫率存在些許差異。
研究結論：本研究探討OPMD之不同類型在惡性轉化風險與醫療行為上的差異，揭示黏膜下纖維化在口腔癌發生中的重要角色。關於黏膜下纖維化在各項風險指標皆超出預期之現象，本研究進一步探討可能成因，並指出該類型為目前最被低估之高風險病變。研究結果亦期盼能補足確診後對於追蹤與治療行為的了解，並為臨床實務與公衛政策提供初步參考。未來可進一步整合篩檢、治療與追蹤策略，進而提升患者風險認知，並加強高風險病變個案的後續管理，以強化整體防治效能。鑑於口腔癌患者常面臨健康不平等的窘境，也期盼相關作為能有助於縮減此類差距。另一方面則是自癌前病變階段就開始預防，也可視為自上游解決問題，這也是公共衛生領域的核心理念。

Oral Potentially Malignant Disorders (OPMD) are defined as "any oral mucosal abnormality that is associated with a statistically increased risk of developing oral cancer." While not all types of OPMD are directly linked to lifestyle habits such as tobacco use, alcohol consumption, or betel quid chewing, Taiwan's government-funded oral mucosal screening program specifically targets high-risk individuals with tobacco and betel quid use. Therefore, the OPMD cases included in this study are primarily associated with these risk factors.
This study utilized data from individuals who were first diagnosed with OPMD through Taiwan's oral cancer screening program between January 1, 2011 and June 30, 2019, enabling an analysis of their subsequent medical utilization, malignant transformation, and long-term outcomes.
The results indicated that homogeneous thin leukoplakia and oral submucous fibrosis (OSF) were the most commonly diagnosed lesions, together representing the majority of cases. Verrucous hyperplasia showed the highest risk of malignant transformation, followed by OSF. However, OSF has long been classified as a low-risk lesion, which is inconsistent with the actual findings. During the follow-up period, most cases did not undergo further intervention, with "no action" being the predominant pattern. This study identifies OSF as an underestimated high-risk lesion and also highlights the lack of healthcare-seeking behavior among patients with various OPMDs after diagnosis. If prevention efforts can begin at the precancerous stage, it would reduce the overall impact of oral cancer on our country.

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