Mai Xiaodan, LaMonte Michael J, Hovey Kathleen M, Nwizu Ngozi, Freudenheim Jo L, Tezal Mine, Scannapieco Frank, Hyland Andrew, Andrews Christopher A, Genco Robert J, Wactawski-Wende Jean
Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, The State University of New York, 270 Farber Hall, Buffalo, NY, 14214, USA,
Cancer Causes Control. 2014 Aug;25(8):1045-53. doi: 10.1007/s10552-014-0405-3. Epub 2014 Jun 10.
While some evidence suggests that periodontal disease (PD) might be positively associated with lung cancer, prospective studies in women are limited. Previous findings may reflect residual confounding by smoking. The study aims to determine whether history of PD diagnosis is associated with incident lung cancer in a large cohort of postmenopausal women.
Prospective analyses were conducted in a cohort of 77,485 postmenopausal women enrolled in the Women's Health Initiative Observational Study. History of PD (prevalence of 26.1 %) was self-reported, and 754 incident lung cancer cases occurred during an average 6.8 (SD ± 2.6) years of follow-up. Cox proportional hazards regression analysis was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs).
Overall, PD was positively associated with lung cancer risk after adjusting for detailed smoking history including smoking status and pack-years of smoking (HR 1.24, 95 % CI 1.07-1.45). There was a positive additive interaction between PD with pack-years of smoking (p = 0.02), suggesting a potential synergistic effect between PD and smoking intensity on lung cancer. The association between PD and lung cancer was stronger in former smokers. When restricted to never-smokers, PD was not associated with lung cancer (HR 1.02, 95 % CI 0.68-1.53).
Periodontal disease was not independently associated with lung cancer in non-smoking postmenopausal women. However, smoking and PD jointly increased lung cancer risk beyond that expected from the sum of the each effect separately. The potential synergism between PD and smoking on lung cancer warrants further examination.
虽然一些证据表明牙周疾病（PD）可能与肺癌呈正相关，但针对女性的前瞻性研究有限。既往研究结果可能反映了吸烟导致的残余混杂因素。本研究旨在确定在一大群绝经后女性中，PD诊断史是否与肺癌发病相关。
对纳入妇女健康倡议观察性研究的77485名绝经后女性队列进行前瞻性分析。PD病史（患病率为26.1%）通过自我报告获得，在平均6.8（标准差±2.6）年的随访期间发生了754例肺癌病例。采用Cox比例风险回归分析来估计风险比（HR）和95%置信区间（CI）。
总体而言，在调整包括吸烟状态和吸烟包年数在内的详细吸烟史后，PD与肺癌风险呈正相关（HR 1.24，95%CI 1.07 - 1.45）。PD与吸烟包年数之间存在正相加交互作用（p = 0.02），表明PD与吸烟强度在肺癌发生上可能存在协同效应。PD与肺癌之间的关联在既往吸烟者中更强。当仅限于从不吸烟者时，PD与肺癌无关（HR 1.02，95%CI 0.68 - 1.53）。
在不吸烟的绝经后女性中，牙周疾病与肺癌无独立关联。然而，吸烟和PD共同增加的肺癌风险超过了各自单独作用的预期之和。PD与吸烟在肺癌发生上的潜在协同作用值得进一步研究。
