Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.
Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital, Seoul, Korea.
J Korean Med Sci. 2021 Apr 19;36(15):e98. doi: 10.3346/jkms.2021.36.e98.
Not so many reports about the association between head and neck cancer (HNC) and oral health status related to periodontitis (OHS-P) has been published in different countries with different methods. So, there is a need for an extensive meta-analysis with the total articles published until 2020. Hence, this study aimed to estimate the association between HNC and OHS-P through a meta-analysis.
Based on Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines, 22 studies were selected through PubMed and Cochrane Library databases. Meta-analysis using them was performed to evaluate the association. The risk of bias assessment using the Newcastle-Ottawa Scale (NOS) was applied to evaluate the quality of non-randomized studies. Publication bias was evaluated by funnel plot and Egger's regression test.
Since heterogeneity was significant (I² = 88%, < 0.001), we adopted the random effect model for 22 studies. Those with bad OHS-P, compared to those with good OHS-P, were more likely to have the risk of HNC by 2.4 times (odds ratio [OR], 2.42; 95% confidence interval [CI], 1.88-3.13) for random effect model. The association included publication bias (Egger's regression, value < 0.001). The association among five studies (I² = 39%, = 0.16) using alveolar bone loss (ABL) or clinical attachment level (CAL) for assessing periodontitis increased to OR of 3.85 (CI, 3.04-4.88) in the fixed effect model without publication bias (Egger's regression, = 0.66). Moreover, the association was higher in 10 fair or good NOS studies (OR, 3.08) and in 7 Asian studies (OR, 2.68), which were from the fixed model without publication bias.
Our meta-analysis showed that bad OHS-P was associated with the risk of HNC. The association was stronger in studies using ABL or CAL for assessing periodontitis.
不同国家采用不同方法发表的关于头颈部癌症（HNC）与牙周炎相关口腔健康状况（OHS-P）之间关联的报道并不多。因此，需要进行一项广泛的荟萃分析，纳入截至 2020 年发表的所有文章。因此，本研究旨在通过荟萃分析评估 HNC 与 OHS-P 之间的关联。
根据系统评价和荟萃分析的首选报告项目，通过 PubMed 和 Cochrane Library 数据库选择了 22 项研究。使用这些研究进行荟萃分析以评估相关性。使用纽卡斯尔-渥太华量表（NOS）进行偏倚风险评估，以评估非随机研究的质量。通过漏斗图和 Egger 回归检验评估发表偏倚。
由于存在显著的异质性（I²=88%，<0.001），我们对 22 项研究采用了随机效应模型。与 OHS-P 良好的患者相比，OHS-P 较差的患者发生 HNC 的风险增加了 2.4 倍（比值比[OR]，2.42；95%置信区间[CI]，1.88-3.13）。该相关性包括发表偏倚（Egger 回归，<0.001）。使用牙槽骨丧失（ABL）或临床附着水平（CAL）评估牙周炎的五项研究（I²=39%，=0.16）之间的相关性在没有发表偏倚的固定效应模型中增加到 3.85（CI，3.04-4.88）（Egger 回归，=0.66）。此外，在 NOS 评分中等或较高的 10 项研究（OR，3.08）和在 7 项亚洲研究（OR，2.68）中，相关性更高，且均来自没有发表偏倚的固定模型。
我们的荟萃分析表明，OHS-P 较差与 HNC 的风险相关。使用 ABL 或 CAL 评估牙周炎的研究中相关性更强。
