Journal of Cancer Research and Therapeutics

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 12  |  Issue : 8  |  Page : 237--240

Correlation between periodontal disease and oral cancer risk: A meta-analysis


Lili Ye, Yinhua Jiang, Weidong Liu, HaiBiao Tao 
 Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000, PR China

Correspondence Address:
Lili Ye
Department of Stomatology, Lishui People's Hospital, The 6th Affiliated Hospital of Wenzhou Medical University, Zhejiang, Lishui 323000
PR China

Abstract

Objective: The purpose of this study is to investigate the correlation between periodontal disease and oral cancer risk by meta-analysis. Methods: We searched the electronic databases of PubMed and Wanfang to include the articles related to periodontal disease and oral cancer risk. The association between periodontal disease and oral cancer risk was assessed by odds ratio (OR) and its corresponding 95% confidence interval (95% CI). The publication bias was evaluated by Begg's funnel plot and Egger's line regression test. All the data analysis was done by STATA12.0 software (Stata Corporation, College Station, TX, USA). Results: Eleven case–control studies were included in our present meta-analysis. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). The Begg's funnel plot was obvious asymmetric indicating significant publication bias. Moreover, further Egger's line regression test also indicated significant publications (t = 3.35, P < 0.05). Conclusion: Our present meta-analysis indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold.



How to cite this article:
Ye L, Jiang Y, Liu W, Tao H. Correlation between periodontal disease and oral cancer risk: A meta-analysis.J Can Res Ther 2016;12:237-240


How to cite this URL:
Ye L, Jiang Y, Liu W, Tao H. Correlation between periodontal disease and oral cancer risk: A meta-analysis. J Can Res Ther [serial online] 2016 [cited 2017 Mar 25 ];12:237-240
Available from: http://www.cancerjournal.net/text.asp?2016/12/8/237/200746


Full Text

 Introduction



Oral cancer originating in any of the tissues in the mouths or any cancerous tissue growth located in the oral cavity is a type of head and neck cancer.[1] It is reported that about 75% oral cancers were related to bad living habits such as tobacco use and excessive alcohol consumption.[2] Moreover, other risk factors for oral cancer are poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by fungi, bacteria, or viruses.[3]

Several studies have also found that periodontal disease may increase the risk of developing oral cancer.[4],[5],[6] However, the each related studies have small number of patients with limited statistical power. In the present study, we collected the published data further analysis evaluate the association between periodontal disease and oral cancer risk meta-analysis.

 Methods



Paper searching

We searched the electronic databases of PubMed and Wanfang to include the articles related to periodontal disease and oral cancer risk using the text word of “oral cancer,” “mouth cancer,” “oral squamous cell carcinoma,” and “periodontal disease.” The searching process was performed by two reviewers independently.

Inclusion and exclusion criteria

Inclusion criteria as follows: (1) study type was case–control study or cohort study; (2) oral cancer diagnosis was confirmed by pathology; (3) the odds ratio (OR) and its 95% confidence interval (CI) was provided by each include studies; and (4) paper published in Chinese or English. Exclusion criteria as follows: (1) case report or reviewer study type; (2) duplicated publications; (3) not provided the OR and 95% CI or cannot calculated the OR with the original data; and (4) published in other languages.

Data extraction

Data of each included studies were extracted by two reviewers independently. The author name, year of the paper published, number of cases included in each study, study type, OR, and its corresponding 95% CI and adjusted factors were extracted.

Statistical analysis

The data analysis was performed by STATA12.0 software (Stata Corporation, College Station, TX, USA). The correlation between periodontal disease and oral cancer risk was demonstrated by OR and its corresponding 95% CI. P <0.05 was statistical significance.

 Results



Publication characteristics

Eleven papers were included in our present study as shown in [Table 1]. All the studies are designed as case–control study. All of the studies were published in English and carried out between 1990 and 2013. The subjects number range from 101 to 1361 with the highest OR of 5.23 and lowest of 1.06. Most of the included studies adjusted for age, gender, smoking, and drinking [Table 1].{Table 1}

Meta-analysis

First, we evaluated the statistical heterogeneity among the included 11 studies by Chi-square. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). This result indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold [Figure 1].{Figure 1}

Publication bias

We use the Begg's funnel plot and Egger's line regression test to investigate the publication bias. The Begg's funnel plot was obvious asymmetric indicating significant publication bias. And further Egger's line regression test also indicated significant publications (t = 3.35, P < 0.05) [Figure 2].{Figure 2}

 Discussion



Periodontal disease is a kind of disease caused by bacterial infection with the clinical features of gingivitis, periodontal tissue damage, and progressive resorption of alveolar bone. The prevalence of periodontal disease is different between races and regions, but its morbidity is increased with the increase of age. The epidemiology study indicated that the periodontal disease incidence was as high as 90%, but the severe periodontal disease incidence was about 10% for the general population.[15] It has been confirmed that the risk factors for periodontal disease were age, race, gender, body mass index, smoking, alcohol consumption, diabetes mellitus, etc.[16]

Oral cancer is the 15th most diagnosed malignant carcinoma with the incidence rate of 3.9/100,000.[9] Oral cancer has become a major public health problem in the worldwide for its increasing incidence and mortality, especially younger trends. In general, the 5-year survival rate for oral cancer was more than 50%.[17],[18] And recently, for the progress of chemoradiation therapy, the 5-year survival rate was on the raise. The early diagnosis and treatment for oral cancer are essential for prognosis. Thereafter, screening the risk factors for oral cancer is important for its prevention. It is reported that about 75% oral cancers were associated with bad living habits such as smoking and excessive alcohol consumption.[10] Moreover, other risk factors for oral cancer are poor oral hygiene, irritation caused by ill-fitting dentures and other rough surfaces on the teeth, poor nutrition, and some chronic infections caused by fungi, bacteria, or viruses. Several studies have also found that periodontal disease may increase the risk of developing oral cancer. However, the each related studies have small number of patients with limited statistical power. We searched the open published studies related to periodontal disease and oral cancer risk. We found 11 case–control studies in our present meta-analysis. We found significant statistical heterogeneity was existed in our present meta-analysis (I2 = 99.8%, P < 0.05). Hence, the data were pooled by random effect model. The pooled results indicated a significant correlation between periodontal disease and oral cancer risk was found with OR = 3.21 and the 95% CI = 2.25–4.16 (P < 0.05). This results indicated that periodontal disease can increase the oral cancer risk by nearly 2-fold.

However, several limitations were existed in our present meta-analysis. The first limitation is heterogeneity, because of the significant statistical heterogeneity; the results should be interpreted cautiously. The second limitation is publication bias; obvious publication made the results unstable. The third limitation is ununified adjusted factors. Thereafter, for the above limitations, well-designed cohort study is needed for further evaluate the correlation between periodontal disease and oral cancer risk.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Santosh AB, Jones T, Harvey J. A review on oral cancer biomarkers: Understanding the past and learning from the present. J Cancer Res Ther 2016;12:486-92.
2Kumar M, Nanavati R, Modi TG, Dobariya C. Oral cancer: Etiology and risk factors: A review. J Cancer Res Ther 2016;12:458-63.
3Patel JB, Shah FD, Joshi GM, Patel PS. Clinical significance of inflammatory mediators in the pathogenesis of oral cancer. J Cancer Res Ther 2016;12:447-57.
4Marshall JR, Graham S, Haughey BP, Shedd D, O'Shea R, Brasure J, et al. Smoking, alcohol, dentition and diet in the epidemiology of oral cancer. Eur J Cancer B Oral Oncol 1992;28B:9-15.
5Talamini R, Vaccarella S, Barbone F, Tavani A, La Vecchia C, Herrero R, et al. Oral hygiene, dentition, sexual habits and risk of oral cancer. Br J Cancer 2000;83:1238-42.
6Guha N, Boffetta P, Wünsch Filho V, Eluf Neto J, Shangina O, Zaridze D, et al. Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: Results of two multicentric case-control studies. Am J Epidemiol 2007;166:1159-73.
7Zheng TZ, Boyle P, Hu HF, Duan J, Jian PJ, Ma DQ, et al. Dentition, oral hygiene, and risk of oral cancer: A case-control study in Beijing, People's Republic of China. Cancer Causes Control 1990;1:235-41.
8Bundgaard T, Wildt J, Frydenberg M, Elbrønd O, Nielsen JE. Case-control study of squamous cell cancer of the oral cavity in Denmark. Cancer Causes Control 1995;6:57-67.
9Garrote LF, Herrero R, Reyes RM, Vaccarella S, Anta JL, Ferbeye L, et al. Risk factors for cancer of the oral cavity and oro-pharynx in Cuba. Br J Cancer 2001;85:46-54.
10Rosenquist K, Wennerberg J, Schildt EB, Bladström A, Göran Hansson B, Andersson G. Oral status, oral infections and some lifestyle factors as risk factors for oral and oropharyngeal squamous cell carcinoma. A population-based case-control study in southern Sweden. Acta Otolaryngol 2005;125:1327-36.
11Tezal M, Sullivan MA, Reid ME, Marshall JR, Hyland A, Loree T, et al. Chronic periodontitis and the risk of tongue cancer. Arch Otolaryngol Head Neck Surg 2007;133:450-4.
12Tezal M, Sullivan MA, Hyland A, Marshall JR, Stoler D, Reid ME, et al. Chronic periodontitis and the incidence of head and neck squamous cell carcinoma. Cancer Epidemiol Biomarkers Prev 2009;18:2406-12.
13Divaris K, Olshan AF, Smith J, Bell ME, Weissler MC, Funkhouser WK, et al. Oral health and risk for head and neck squamous cell carcinoma: The Carolina Head and Neck Cancer Study. Cancer Causes Control 2010;21:567-75.
14Ansai T, Takata Y, Yoshida A, Soh I, Awano S, Hamasaki T, et al. Association between tooth loss and orodigestive cancer mortality in an 80-year-old community-dwelling Japanese population: A 12-year prospective study. BMC Public Health 2013;13:814.
15Ebersole JL, Graves CL, Gonzalez OA, Dawson D 3rd, Morford LA, Huja PE, et al. Aging, inflammation, immunity and periodontal disease. Periodontol 2000 2016;72:54-75.
16Chatzopoulos G. Smoking, smokeless tobacco, and alcohol consumption as contributing factors to periodontal disease. Northwest Dent 2016;95:37-41.
17Buglione M, Cavagnini R, Di Rosario F, Maddalo M, Vassalli L, Grisanti S, et al. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Xerostomia and trismus (Part 2). Literature review and consensus statement. Crit Rev Oncol Hematol 2016;102:47-54.
18Sultana J, Bashar A, Molla MR. New management strategies of oral tongue cancer in Bangladesh. J Maxillofac Oral Surg 2014;13:394-400.