State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
State Key Laboratory of Biotherapy and Department of Lung Cancer Center and Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu, China.
J Periodontal Res. 2020 Oct;55(5):581-593. doi: 10.1111/jre.12772. Epub 2020 Jun 25.
Periodontal disease (PD), as a chronic bacterial infection, might cause cardiovascular and some other systemic diseases, with recent studies reporting that it exhibits some connection with lung cancer. While studies have shown that poor oral health might increase the risk of lung cancer, the veracity of these reports is questionable. Therefore, this meta-analysis was undertaken to investigate the association between PD and the risk of lung cancer. A search was run in PubMed, EMBASE, MEDLINE, CENTRAL, and ClinicalTrials.gov databases up to January 1, 2020. Cohort and case-control studies investigating the correlation between PD and lung cancer were included. Eligibility assessment and data extraction were conducted independently, and a meta-analysis was performed to synthesize the data. The association between PD, edentulism, and lung cancer was measured by the adjusted hazard ratios (HRs) or odds ratios (ORs) and their 95% confidence intervals (CIs) provided in articles. We employed appropriate effect model in terms of I (a fixed-effect model for PD and a random-effect model for edentulism) to obtain summary effect estimates. Statistical heterogeneity was investigated by chi-square test and I statistics. Newcastle-Ottawa Scale (NOS) was used to assess the quality of their method. Six cohort studies (eight references) and two case-control studies, assessed as high-quality, involving 167 256 participants, were included in the review. The summary estimates based on adjusted data showed an association between PD and a significant risk of lung cancer both in cohort studies (HR = 1.40, 95% CI = 1.25-1.58; I = 8.7%) and case-control studies (OR = 1.51, 95% CI = 1.16-1.98; I = 36.5%). Similar features were found in the sensitivity analysis and subgroups for six cohort studies, of male only (HR = 1.36, 95% CI = 1.15-2.60), setting the lung cancer incidence as endpoint (HR = 1.39, 95% CI = 1.24-1.57; I = 23.9%), and adjusting alcohol for multifactorial HR (HR = 1.38, 95% CI = 1.21-1.57; I = 39.9%). The summary HR for edentulism was 1.93 (95% CI = 1.05-3.57; I = 55.3%). No obvious publication bias was detected. This systematic review and meta-analysis demonstrated a significant association between PD and the incidence of lung cancer. Further observational studies are required by using standardized measurements to assess the periodontal status and by eliminating confounding factors, such as alcohol and diabetes, to verify such a relationship.
牙周病（PD）作为一种慢性细菌性感染，可能导致心血管和其他一些系统性疾病，最近的研究报告表明，它与肺癌之间存在一定的关联。虽然研究表明口腔健康状况不佳可能会增加患肺癌的风险，但这些报告的真实性值得怀疑。因此，进行了这项荟萃分析，以调查 PD 与肺癌风险之间的关系。在 PubMed、EMBASE、MEDLINE、CENTRAL 和 ClinicalTrials.gov 数据库中进行了截至 2020 年 1 月 1 日的搜索。纳入了队列和病例对照研究，以调查 PD 与肺癌之间的相关性。独立进行了资格评估和数据提取，并进行了荟萃分析以综合数据。使用文章中提供的调整后的危害比（HR）或比值比（OR）及其 95%置信区间（CI）来衡量 PD、无牙和肺癌之间的关联。我们根据 I（PD 采用固定效应模型，无牙采用随机效应模型）采用了适当的效应模型来获得汇总效应估计。通过卡方检验和 I 统计量来研究统计异质性。纽卡斯尔-渥太华量表（NOS）用于评估其方法的质量。共纳入了六项队列研究（八个参考文献）和两项病例对照研究，这些研究质量较高，共涉及 167256 名参与者。基于调整后的数据的汇总估计显示，PD 与肺癌发生显著风险之间存在关联，无论是在队列研究中（HR=1.40，95%CI=1.25-1.58；I=8.7%）还是在病例对照研究中（OR=1.51，95%CI=1.16-1.98；I=36.5%）。对六个队列研究的敏感性分析和亚组分析也得到了类似的结果，仅对男性（HR=1.36，95%CI=1.15-2.60）、以肺癌发生率为终点（HR=1.39，95%CI=1.24-1.57；I=23.9%）和调整多因素 HR 中的酒精（HR=1.38，95%CI=1.21-1.57；I=39.9%）进行了分析。无牙的汇总 HR 为 1.93（95%CI=1.05-3.57；I=55.3%）。未发现明显的发表偏倚。这项系统评价和荟萃分析表明，PD 与肺癌的发生之间存在显著关联。需要进一步的观察性研究，使用标准化测量来评估牙周状况，并消除混杂因素，如酒精和糖尿病，以验证这种关系。
