The pathology reports and original biopsy request forms for all specimens received by the Department of Oral and Maxillofacial Surgery, Nara Medical University, between 1995 and 2015 were retrospectively reviewed. Lesions clinically characterized as white plaques/lesions of the oral mucosa and pathologically diagnosed as having oral epithelial dysplasia (OED) were included. Clinical information including age, sex, smoking and alcohol habits, site of lesion, histopathological details and type of treatment method were retrieved from the patients’ medical records. The exclusion criteria included a previous diagnosis of OSCC/OED, OED with concomitant OSCC at the first visit, insufficient sample for analysis, and insufficient clinical information.

Cigarette equivalents were calculated as follows: one pipe equaled three cigarettes, and one cigar equaled two cigarettes. Smokers were defined as those who had smoked >100 cigarettes (or the equivalent) over the course of their lifetime [23]. Current drinkers were defined as those who had consumed alcoholic beverages of any type within 1 year prior to the date of diagnosis. Former drinkers were defined as those who had never drank or those who had discontinued drinking for >1 year prior to the date of diagnosis [15, 2426].

This study and all experimental procedures were approved by the ethics committee of Nara Medical University, Nara, Japan (approval date: April 21, 2014; approval number: 827). Informed consent was waived because of the retrospective design, and the analysis used anonymous data. The work was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki).

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