Tsai Kuo-Yang, Su Che-Chun, Chiang Chi-Ting, Tseng Yao-Ting, Lian Ie-Bin
Department of Oral and Maxillofacial Surgery, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan.
Department of Internal Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan; Graduate Institute of Statistics and Information Science, National Changhua University of Education, Changhua 500, Taiwan.
Cancer Epidemiol. 2017 Apr;47:118-124. doi: 10.1016/j.canep.2017.02.003. Epub 2017 Mar 2.
Oral cancer (OC) is a leading cause of death from cancer in men between the ages of 25 and 44 years in Taiwan. The overall 5-year survival rates for the four OC stages (I-IV) in Taiwan are approximately 70%, 30%, 20%, and 10%, respectively, indicating the importance of the early diagnosis of oral potentially malignant disorders (OPMDs). Previous studies indicated an association between the OC incidence and certain environmental heavy metal concentrations. If these associations do exist for OC, they may also be observed for OPMD. The purpose of this study is to explore the association between the development of OPMD to OC and environmental heavy metals. Oral submucous fibrosis (OSF) and oral leukoplakia (OL) are two major types of OPMD in Taiwan.
A retrospective cohort study was conducted by Changhua Christian Hospital, the sole medical center in Changhua County, where 2725 male adult patients diagnosed with either OSF or OL between 2000 and 2014 were recruited. Data were analyzed by Cox regression and adjusted for smoking and betel-quid chewing.
OPMD patients who resided in areas with high nickel concentrations (polluted levels) exhibited hazard ratios of 1.8-2 for OC relative to those who lived in areas with low nickel levels (P<0.01). Meanwhile, smokers with OPMDs had a hazard ratio of 2.8-2.9 relative to non-smokers. Betel-quid chewers had a 2.2-2.3 hazard ratio relative to non-chewers. Smoking, betel-quid chewing, and environmental nickel exposure are associated with an increased risk of OC development in OPMD patients. This study provides valuable findings on the environmental effects of heavy metals on human health. Enhanced surveillance of the condition of OPMD patients who have been exposed to high nickel concentrations may be crucial for OC prevention.
口腔癌（OC）是台湾25至44岁男性癌症死亡的主要原因。台湾口腔癌四个阶段（I - IV期）的总体5年生存率分别约为70%、30%、20%和10%，这表明早期诊断口腔潜在恶性疾病（OPMDs）的重要性。先前的研究表明口腔癌发病率与某些环境重金属浓度之间存在关联。如果这些关联确实存在于口腔癌中，那么在口腔潜在恶性疾病中也可能观察到。本研究的目的是探讨口腔潜在恶性疾病发展为口腔癌与环境重金属之间的关联。口腔黏膜下纤维化（OSF）和口腔白斑（OL）是台湾两种主要的口腔潜在恶性疾病类型。
彰化基督教医院进行了一项回顾性队列研究，彰化县唯一的医疗中心招募了2000年至2014年间诊断为口腔黏膜下纤维化或口腔白斑的2725名成年男性患者。数据通过Cox回归分析，并对吸烟和嚼槟榔进行了校正。
居住在高镍浓度（污染水平）地区的口腔潜在恶性疾病患者患口腔癌的风险比居住在低镍水平地区的患者高1.8至2倍（P<0.01）。同时，患有口腔潜在恶性疾病的吸烟者患口腔癌的风险比不吸烟者高2.8至2.9倍。嚼槟榔者患口腔癌的风险比不嚼槟榔者高2.2至2.3倍。吸烟、嚼槟榔和环境镍暴露与口腔潜在恶性疾病患者患口腔癌的风险增加有关。本研究提供了关于重金属对人类健康的环境影响的有价值的发现。加强对暴露于高镍浓度环境的口腔潜在恶性疾病患者病情的监测可能对预防口腔癌至关重要。
