Department of Otolaryngology/Head and Neck Surgery, UNC School of Medicine; 170 Manning Drive, Chapel Hill, NC 27599-7070, USA.
Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC 27599-7450, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7435, USA.
Oral Oncol. 2017 Oct;73:111-117. doi: 10.1016/j.oraloncology.2017.08.009.
Poor oral health has emerged as a risk factor for squamous cell carcinoma of the head and neck (HNSCC) but its impact on survival has not been examined. We sought to estimate the impact of oral health indicators on survival in a population-based HNSCC cohort.
Cases (n=1381) and age-, sex- and race-matched controls (n=1396) were participants in the Carolina Head and Neck Cancer Epidemiologic Study (CHANCE). Vital status was determined via linkage with the National Death Index. Survival was considered at 5years post-diagnosis or study-enrollment for controls. Oral health was assessed using self-reported indicators including frequency of routine dental exams and tooth brushing. We used Kaplan-Meyer analyses and Cox regression to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CI).
Routine dental visits during the preceding 10years were associated with decreased mortality risk (>10 visits: HR=0.6, 95% CI=0.4-0.8) after adjusting for confounders. This effect was most pronounced for oral cavity cancer-(e.g., >10 visits: HR=0.4, 95% CI=0.2-0.9). Dental visits were also positively associated with survival among controls. No other routine health screening (e.g., eye exams) was associated with survival.
We found significant associations between markers of oral health and survival among both HNSCC cases and controls. This association was most pronounced for sites closer to the dentition. Oral health may have a direct effect on tumor biology due to the associated immune or inflammatory response. It may also represent a proxy for wellness or unmeasured social determinants of health.
口腔健康状况不佳已成为头颈部鳞状细胞癌（HNSCC）的危险因素，但尚未研究其对生存的影响。我们试图评估口腔健康指标对头颈部癌症患者人群生存的影响。
病例组（n=1381）和年龄、性别及种族匹配的对照组（n=1396）均为卡罗来纳头颈部癌症流行病学研究（CHANCE）的参与者。通过与国家死亡指数的链接确定生存状态。对照组的生存时间从诊断或研究入组后 5 年开始计算。使用自我报告的指标评估口腔健康，包括常规牙科检查和刷牙的频率。我们使用 Kaplan-Meier 分析和 Cox 回归来估计调整后的风险比（HR）和 95%置信区间（CI）。
在调整混杂因素后，过去 10 年内定期看牙医与降低死亡率相关（>10 次就诊：HR=0.6，95%CI=0.4-0.8）。这种影响在口腔癌患者中最为显著（例如，>10 次就诊：HR=0.4，95%CI=0.2-0.9）。定期看牙医也与对照组的生存呈正相关。其他常规健康检查（如眼科检查）与生存无关。
我们发现口腔健康标志物与 HNSCC 病例和对照组的生存之间存在显著关联。这种关联在与牙齿更接近的部位最为明显。由于与免疫或炎症反应相关，口腔健康可能对头颈部癌症的生物学产生直接影响。它也可能代表健康状况或未测量的健康社会决定因素的替代指标。
