Periodontal disease and risk of head and neck cancer: a meta-analysis of observational studies

Abstract

Background: Many epidemiological studies have found a positive association of periodontal disease (PD) with risk of head and neck cancer (HNC), but the findings are varied or even contradictory. In this work, we performed a meta-analysis to ascertain the relationship between PD and HNC risk.

Methods: We searched the PubMed, Embase, and Cochrane Library databases for relevant observational studies on the association between PD and HNC risk published up to March 23, 2013. Data from the included studies were extracted and analyzed independently by two authors. Meta-analysis was performed using RevMan 5.2 software.

Results: We obtained seven observational studies involving two cohort and six case-control studies. Random-effects meta-analysis indicated a significant association between PD and HNC risk (odds ratio = 2.63, 95% confidence interval = 1.1.68 - 4.14; p < 0.001), with sensitivity analysis showing that the result was robust. Subgroup analyses based on adjustment for covariates, study design, PD assessment, tumor site, and ethnicity also revealed a significant association.

Conclusions: Based on currently evidence, PD is probably a significant and independent risk factor of HNC.

Figure 1. Flow chart from identification of eligible studies to final inclusion.

PD, periodontal disease; HNC, head and neck cancer.

Figure 2. Forest plot of periodontal disease and risk of head and neck cancer, studies are pooled with random-effects model.

Guha E 2007, the study conducted in Europe, included Russia, Romania, and Poland; Guha LA 2007, the study conducted in Latin-America, included Argentina, Cuba, and Brazil.

Figure 3. Funnel plot based on overall results of included 2 cohort and 6 case-control studies.

Guha E 2007, the study conducted in Europe, included Russia, Romania, and Poland; Guha LA 2007, the study conducted in Latin-America, included Argentina, Cuba, and Brazil.