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. 2024 Nov 19;24(1):1406.
doi: 10.1186/s12903-024-05170-0.

Periodontitis and dental quality of life predict long-term survival in head and neck cancer

Mirna Farran  1   2 , Evelyn Neppelberg  1   2   3 , Sigbjørn Løes  1   4 , Anne K H Aarstad  3   5 , Svein Erik Moe  3 , Hans Jørgen Aarstad  6   7
Affiliations

Periodontitis and dental quality of life predict long-term survival in head and neck cancer

Mirna Farran et al. BMC Oral Health. .

Abstract

Background: Our aim was to investigate oral health in newly diagnosed head and neck squamous cell carcinoma (HNSCC) patients in relation to long-term survival. We assessed whether the level of alveolar bone loss due to periodontitis at diagnosis, measured from orthopantomogram (OPG), and reported dental health-related quality of life (HRQoL) scores obtained at diagnosis contain prognostic information for HNSCC patients.

Methods: A total of 79 patients from a consecutive cohort of 106 diagnosed with HNSCC between November 2002 and June 2005 were included. All patients reported dental HRQoL, OPG-determined alveolar bone loss were measured in 79 patients at diagnosis. Reduced alveolar bone loss (≥ 4 mm) from cement-enamel junction on at least two molars or premolars registered both horizontally and vertically served as indicator of periodontal disease.

Results: With alveolar bone loss, we determined increased mortality by univariate analysis (RR = 2.28, CI: 1.22-4.28, p = 0.01) and a strong trend by multivariate analyses adjusted for standard clinical information (RR = 1.95, CI: 0.98-3.87, p = 0.056). Reported lowered dental HRQoL scores predicted long-term survival in both univariate (RR = 3.58, CI: 1.99-6.45, p < 0.001) and multivariate adjusted for standard clinical information (RR = 2.17, CI: 1.17-4.01, p = 0.014). When analyzed with Cox regression, including alveolar bone loss and dental HRQoL, both factors, adjusted by clinical variables, were significant predictors of long-term survival: dental HRQoL (p = 0.007) and present alveolar bone loss (p = 0.034). Non-HNSCC disease-specific long-term survival predicted was also predicted when alveolar bone loss and dental HRQoL were analyzed simultaneously and adjusted for standard clinical information.

Conclusions: The degree of alveolar bone loss, as determined by OPG, and dental HRQoL both obtained at the time of HNSCC diagnosis, predicted long-term survival. When analyzed simultaneously, both factors remained significant in both univariate and multivariate analyses, adjusted by pertinent clinical variables, highlighting their unique prognostic value.

Keywords: Carcinoma; HPV; Head and neck; Health-related quality of life; Oral health; Periodontitis.

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Conflict of interest statement

Declarations Ethics approval and consent to participate The study was approved by the Norwegian regional ethics committee (REK VEST 2011 − 125) and performed in accordance with the Declaration of Helsinki. Informed consent to participate was obtained from all the participants in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier 5-year overall survival dependent on reported dental HRQoL and the presence of alveolar bone loss. (A) 5-year overall survival of HNSCC patients based on reported dental HRQoL. Dental HRQoL was assessed using the EORTC H&N35 questionnaire answered at diagnosis. High reported dental HRQoL is shown in blue, and low dental HRQoL is shown in orange. (B) 5-year overall survival of HNSCC patients based on the presence of alveolar bone loss. Alveolar bone loss was determined from OPGs at diagnosis, with measurements indicating reduced alveolar bone loss (≥ 4 mm) from the cement-enamel junction on at least two teeth both horizontally and vertically, defined as extended periodontitis. No/limited alveolar bone loss is shown in blue, and extended alveolar bone loss is shown in orange. The Y-axis represents the probability of survival, and the X-axis denotes time in months. Differences between the groups are examined with log-rank tests and presented with p-values
Fig. 2
Fig. 2
Kaplan-Meier 5-year overall survival dependent on reported dental HRQoL and the presence of alveolar bone loss, stratified by HPV status. (A) HPV(−): 5-year overall survival by reported dental HRQoL. (B) HPV(+): 5-year overall survival by reported dental HRQoL. High reported dental HRQoL is shown in blue, and low dental HRQoL is shown in orange. (C) HPV(−): 5-year overall survival by alveolar bone loss. (D) HPV(+): 5-year overall survival by alveolar bone loss. No/limited alveolar bone loss is shown in blue, and extended alveolar bone loss is shown in orange. The Y-axis represents the probability of survival, and the X-axis denotes time in months. Differences between the groups are examined with log-rank tests and presented with p-values
Fig. 3
Fig. 3
Kaplan-Meier long-term overall survival dependent on reported dental HRQoL and presence of alveolar bone loss, stratified by HPV status. (A) HPV(−): Long-term overall survival by reported dental HRQoL. (B) HPV(+): Long-term overall survival by reported dental HRQoL. High reported dental HRQoL is shown in blue, and low dental HRQoL is shown in orange. (C) HPV(−): Long-term overall survival by alveolar bone loss. (D) HPV(+): Long-term overall survival by alveolar bone loss. No/limited alveolar bone loss is shown in blue, and extended alveolar bone loss is shown in orange. The Y-axis represents the probability of survival, and the X-axis denotes time in months. Differences between the groups are examined with log-rank tests and presented with p-values
Fig. 4
Fig. 4
Kaplan-Meier long-term survival among index HNSCC disease-specific survivors, dependent on reported dental HRQoL and the presence of alveolar bone loss, stratified by HPV status (A) HPV(−): Long-term overall survival among HNSCC disease-specific survivors by reported dental HRQoL. (B) HPV(+): Long-term overall survival among HNSCC-disease-specific survivors by reported dental HRQoL. High reported dental HRQoL in blue, and low dental HRQoL is shown in orange. (C) HPV(−): Long-term overall survival among HNSCC-disease-specific survivors by alveolar bone loss. (D) HPV(+): Long-term overall survival among HNSCC disease-specific survivors by alveolar bone loss. No/limited alveolar bone loss is shown in blue, and extended alveolar bone loss is shown in orange The Y-axis represents the probability of survival and, and the X-axis represents time in months. Differences between groups are examined with the log-rank tests and presented with p-values
Fig. 5
Fig. 5
Long-term survival of HNSCC patients by reported dental HRQoL adjusted by alveolar bone loss, and by alveolar bone loss adjusted by reported dental HRQoL. (A) No/limited alveolar bone loss. (B) Extended alveolar bone loss. High reported dental HRQoL is shown in blue, and low dental HRQoL is shown in orange. (C) Low reported dental HRQoL (D) High reported dental HRQoL. No/limited alveolar bone loss is shown in blue, and extended alveolar bone loss is shown in orange. The Y-axis represents the probability of survival, and the X-axis denotes time in months. Differences between groups are examined with log-rank tests and presented with p-values. Statistics: p < 0.001 combined
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