复合口腔卫生评分与口腔癌及其亚型风险：一项大规模倾向评分匹配研究。
A composite oral hygiene score and the risk of oral cancer and its subtypes: a large-scale propensity score-based study.
机构信息
Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, 1 Xueyuan Road, Fuzhou, 350108, Fujian, China.
Key Laboratory of Ministry of Education for Gastrointestinal Cancer, Fujian Medical University, Fuzhou, China.
出版信息
Clin Oral Investig. 2022 Mar;26(3):2429-2437. doi: 10.1007/s00784-021-04209-8. Epub 2021 Oct 10.
OBJECTIVE
This study aimed to investigate the potential relationship between oral hygiene and the risk of oral cancer and its subtypes after controlling the effects of several confounding factors.
MATERIALS AND METHODS
A large-scale case-control study was conducted from January 2010 to August 2019, recruiting a total of 1,288 oral cancer cases with newly diagnosed and 4,234 healthy controls. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to minimize confounding effects. Conditional logistic regression was used to evaluate the effects of oral hygiene indicators on oral cancer.
RESULTS
A composite oral hygiene score was developed based on five indicators selected based on PSM and IPTW analysis (including tooth loss, dentures wearing, the frequency of tooth brushing, regular dental visits, and recurrent dental ulcer). Participants with a higher score, compared with their lower counterparts, showed a 49% increased risk (the odds ratio (OR) was 1.49 (95% confidence interval (CI): 1.26-1.75). A similar association pattern was found following IPTW analyses (OR = 1.32; 95% CI: 1.22-1.42). Of note, the adverse effects of poor oral hygiene were more evident among the sites of gingival and buccal (PSM analysis: 2.03-fold and 2.68-fold increased risk; IPTW analysis: 1.57-fold and 2.07-fold increased risk, respectively). Additionally, a greater positive association was observed between poor oral hygiene and oral squamous cell carcinoma, compared with other pathological types.
CONCLUSION
This study establishes a composite oral hygiene score and provides supportive evidence of poor oral hygiene associated with a higher risk of oral cancer, particularly in the gingival and buccal mucosa sites and in the squamous cell carcinoma.
CLINICAL RELEVANCE
The data highlights the importance of improving poor oral hygiene habits, which has public health implications for the prevention of oral cancer.
目的
本研究旨在探讨口腔卫生与口腔癌及其亚型风险之间的潜在关系，同时控制了多种混杂因素的影响。
材料与方法
本研究为一项大规模病例对照研究，于 2010 年 1 月至 2019 年 8 月进行，共纳入 1288 例初诊口腔癌病例和 4234 例健康对照。采用倾向评分匹配（PSM）和逆概率处理加权（IPTW）法来最小化混杂效应。采用条件逻辑回归评估口腔卫生指标对口腔癌的影响。
结果
基于 PSM 和 IPTW 分析选择的 5 项指标（包括牙齿缺失、佩戴义齿、刷牙频率、定期看牙医和复发性口腔溃疡），构建了一个综合口腔卫生评分。与得分较低者相比，得分较高者的口腔癌风险增加了 49%（比值比[OR]为 1.49，95%置信区间[CI]：1.26-1.75）。在 IPTW 分析中也观察到类似的关联模式（OR=1.32；95% CI：1.22-1.42）。值得注意的是，在牙龈和颊黏膜部位，不良口腔卫生的不良影响更为明显（PSM 分析：风险增加 2.03 倍和 2.68 倍；IPTW 分析：风险增加 1.57 倍和 2.07 倍）。此外，与其他病理类型相比，不良口腔卫生与口腔鳞状细胞癌之间的相关性更强。
结论
本研究构建了一个综合口腔卫生评分，并提供了支持性证据，表明不良口腔卫生与口腔癌风险增加相关，尤其是在牙龈和颊黏膜部位以及口腔鳞状细胞癌中。
临床意义
数据强调了改善不良口腔卫生习惯的重要性，这对预防口腔癌具有公共卫生意义。
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