Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study
Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study
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DOI：
10.1016/s1470-2045(08)70106-2
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发表时间：
2008-06-01
期刊：
影响因子：
51.1
通讯作者：
Joshipura, Kaumudi
中科院分区：
文献类型：
--
作者：
Michaud, Dominique S.;Liu, Yan;Joshipura, Kaumudi
背景研究表明，牙齿脱落和牙周病可能会增加患各种癌症的风险；然而，吸烟可能会混淆已报道的联系。我们的目的是评估牙周病或牙齿脱落是否与癌症风险有关。方法这项分析是在1986年发起的一项前瞻性研究(卫生专业人员跟踪研究[HPFS])中进行的，该研究由美国马萨诸塞州波士顿哈佛大学公共卫生学院营养系发布的调查问卷发起。除了基线问卷外，每2年向所有在世参与者发布一次跟踪调查问卷，每4年向所有在世参与者发布一次饮食调查问卷。在基线时，参与者被问及是否有伴有骨质流失的牙周病病史。参与者还报告了基线时的自然牙齿数量，并在后续问卷中报告了前两年的牙齿脱落情况。在基线和随后的所有问卷中获得吸烟状况和吸烟史。此外，在基线时，参与者在一份包含131个项目的半定量食物频率问卷上报告了他们在前一年的平均食物摄入量。参与者在后续问卷中报告了任何新的癌症诊断。这项研究的终点是总癌症风险和个体癌症风险，超过100例。根据牙周疾病状况和基线牙数，用COX比例风险模型计算多变量风险比(HRs)和95%的CI。在主要分析中，48375名男性在排除1986年前被诊断为癌症(非黑色素瘤皮肤癌，n=2076)和牙周病资料缺失的患者(n=1078)后，中位随访时间为17.7年(1986年至2004年1月31日)。记录了5720例癌症事件(不包括非黑色素瘤皮肤癌和非侵袭性前列腺癌)。最常见的5种癌症分别是结直肠癌(n=1043)、皮肤黑色素瘤(n=698)、肺癌(n=678)、膀胱癌(n=543)和晚期前列腺癌(n=541)。在调整了已知的风险因素，包括详细的吸烟史和饮食因素后，有牙周病病史的参与者患总癌症的风险比没有牙周病病史的人高(HR 1.14[95%CI 1.07-1.22])。按肿瘤部位划分，肺癌(1.36[1.15-1.60])、肾(1.49[1.12-1.97])、胰腺(1.54[1.16-2.04]；先前发表的研究结果)和血液病(1.30[1.11-1.53])与有牙周病病史的患者显著相关。基线(0-16)牙齿较少与肺癌风险增加(1.70[1.37-2.11])相关，0-16颗牙齿与25-32颗牙齿相比。在从不吸烟的人中，牙周病与总数(1.21[1.06-1.39])和血液病癌症(1.35[1.01-1.81])显著增加相关。相比之下，没有发现肺癌的相关性(0.96[0.46-1.98])。解释性牙周病与总体癌症风险的微小但显著的增加有关，这种情况在从不吸烟的人中持续存在。肺癌的相关记录可能是由于吸烟造成的残留混淆。血液病、肾癌和胰腺癌的风险增加需要证实，但这表明牙周病可能是易感免疫系统的标志，或者可能直接影响癌症风险。
Background Studies suggest that tooth loss and periodontal disease might increase the risk of developing various cancers; however, smoking might have confounded the reported associations. We aimed to assess whether periodontal disease or tooth loss is associated with cancer risk.Methods The analysis was done in a prospective study (the Health Professionals Follow-Up Study [HPFS]), which was initiated in 1986 when US male health professionals aged 40-75 years responded to questionnaires posted by the Department of Nutrition, Harvard University School of Public Health, Boston, MA, USA. In addition to the baseline questionnaires, follow-up questionnaires were posted to all living participants every 2 years and dietary questionnaires every 4 years. At baseline, participants were asked whether they had a history of periodontal disease with bone loss. Participants also reported number of natural teeth at baseline and any tooth loss during the previous 2 years was reported on the follow-up questionnaires. Smoking status and history of smoking were obtained at baseline and in all subsequent questionnaires. Additionally at baseline, participants reported their mean frequency of food intake over the previous year on a 131-item semiquantitative food-frequency questionnaire. Participants reported any new cancer diagnosis on the follow-up questionnaires. Endpoints for this study were risk of total cancer and individual cancers with more than 100 cases. Multivariate hazard ratios (HRs) and 95% CIs were calculated by use of Cox proportional hazard models according to periodontal disease status and number of teeth at baseline.Findings In the main analyses, 48 375 men with median follow-up of 17.7 years (1986 to Jan 31, 2004) were eligible after excluding participants diagnosed with cancer before 1986 (other than non-melanoma skin cancer, n = 2076) and those with missing data on periodontal disease (n = 1078). 5720 incident cancer cases were documented (excluding non-melanoma skin cancer and non-aggressive prostate cancer). The five most common cancers were colorectal (n = 1043), melanoma of the skin (n = 698), lung (n = 678), bladder (n = 543), and advanced prostate (n = 541). After adjusting for known risk factors, including detailed smoking history and dietary factors, participants with a history of periodontal disease had an increased risk of total cancer (HR 1.14 [95% CI 1.07-1.22]) compared with those with no history of periodontal disease. By cancer site, significant associations for those with a history of peridontal disease were noted for lung (1.36 [1.15-1.60]), kidney (1.49 [1.12-1.97]), pancreas (1.54 [1.16-2.04]; findings previously published), and haematological cancers (1.30 [1.11-1.53]). Fewer teeth at baseline (0-16) was associated with an increase in risk of lung cancer (1.70 [1.37-2.11]) for those with 0-16 teeth versus those with 25-32 teeth. In never-smokers, periodontal disease was associated with significant increases in total (1.21 [1.06-1.39]) and haematological cancers (1.35 [1.01-1.81]). By contrast, no association was noted for lung cancer (0.96 [0.46-1.98]).Interpretation Periodontal disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. The associations recorded for lung cancer are probably because of residual confounding by smoking. The increased risks noted for haematological, kidney, and pancreatic cancers need confirmation, but suggest that periodontal disease might be a marker of a susceptible immune system or might directly affect cancer risk.Funding National Cancer Institute, National Institutes of Health, Bethesda, MD, USA (grant number P01CA055075).