Unveiling mechanistic effects of mast cell in the progression of fibrosis and malignant transformation of oral submucous fibrosis: a systematic review and meta-analysis

Oral submucous fibrosis (OSMF) is a ubiquitous fatal fibrotic mucosal disease with multifactorial etiology and complex pathogenesis. The role of mast cells in the pathophysiology of OSMF remains uncharted territory owing to a dearth of studies. Thus, the present systematic review and meta-analysis aimed to unentangle the mysteric role of mast cells in the pathogenesis, progression of fibrosis and malignant transformation of OSMF. Using various databases, full-text articles that investigated mast cell concentrations in OSMF were entailed for review. A modified Newcastle-Ottawa scale was employed to evaluate the risk of bias in all articles and Review Manager was utilized for meta-analysis. Twenty and fourteen qualified articles, respectively, were included for qualitative and quantitative data synthesis. Progressive amplification of mast cell density is linked with fibrosis-induced malignant transformation of OSMF. The fixed-effect model also confirmed that significantly upregulated mast cell counts have a decreased risk of association with control as well as a significantly increased risk of being associated with early-stage fibrosis and malignant transformation of OSMF. This review authenticates the mechanistic effects of mast cells in the pathogenesis, chronicity, progression of fibrosis and malignant transformation of OSMF.