Association between serum nickel and oral cancer incidence using propensity score matching and inverse probability of treatment weighting / 环境与职业医学

Background The association between serum nickel (Ni) and oral cancer incidence is unclear and most of the previous studies were observational studies that did not control for confounding factors between groups. Objective To assess the correlation of serum Ni with oral cancer incidence based on propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Methods A cohort of 456 newly diagnosed oral cancer patients was recruited from the First Hospital of Fujian Medical University during November 2011 to May 2019, and residents ordered their health check-up in hospitals or local community health centers over the same period were selected as a control group, which included a total of 1410 participants. Serum Ni was evaluated by inductively coupled plasma mass spectrometry. Case-control pairs were selected using a 1:1 PSM (caliper value of 0.02), and the study subjects in the case group and control group were weighted for subsequent analysis by IPTW. The general characteristics of the study subjects were tested for equilibrium before and after matching by chi-square test and standardized mean difference (SMD). This was followed by exploring the potential nonlinear dose-response relationship between serum Ni and oral cancer using restricted cubic splines as well as analyzing the association between serum Ni and oral cancer incidence by conditional logistic regression and weighted logistic regression. Results After controlling for between-group covariates by PSM and IPTW, the dose-response curves demonstrated that the risk of developing oral cancer tended to decline and then increase with the increasing serum Ni level. The outcome of the analysis using PSM demonstrated that as compared to the control group, the risk of developing oral cancer in the 0.09-16.80 μg·L−1 serum Ni group was negatively correlated with serum Ni level (OR=0.36, 95%CI: 0.24-0.54), whereas the risk of developing oral cancer in the >16.80 μg·L−1 serum Ni group was positively correlated with serum Ni level (OR=5.43, 95%CI: 2.76-10.68). After applying IPTW, a negative association was found between the risk of oral cancer and serum Ni concentration within a serum Ni window ranging from 0.09 to 20.55 μg·L−1 (OR=0.39, 95%CI: 0.29-0.52), while a positive association with an OR and 95%CI of 5.54 (3.62-8.49) for the Ni concentration > 20.55 μg·L−1. Conclusion In this study, a J-shaped relationship between serum Ni concentration and the risk of developing oral cancer is found, which shows that high serum Ni concentration (>20.55 μg·L−1) may be a risk factor for oral cancer.

Relationship between selenium and the risk for oral cancer: a case-control study / 中华流行病学杂志

Objective@#To explore the relationship between selenium and the risk for oral cancer.@*Methods@#We performed a case-control study in 325 cases of newly diagnosed primary oral cancer from the First Affiliated Hospital of Fujian Medical University and 650 controls from the same hospital and community. Unconditional logistic regression and stratification analyses were used to explore the association between selenium and oral cancer. Adjusted OR and corresponding 95%CI were calculated. The analyses on multiple interactions between selenium and smoking or drinking status, and fruit or fish intake frequencies were conducted.@*Results@#The level of serum selenium was 112.42 (80.98-145.06) μg/L in the case group, which was lower than 164.85 (144.44-188.53) μg/L in control group, the difference was statistical significant (P<0.01). There was a negative correlation between serum selenium level and the risk for oral cancer regardless of smoking and drinking status, and fruits and fish intake frequencies (P<0.05). There were multiple interactions between serum selenium level and smoking or drinking status, and fruit and fish intakes.@*Conclusions@#The high level of serum selenium is a protective factor for the incidence of oral cancer, and serum selenium has multiple interactions with smoking or drinking status, and fruit and fish intakes. Therefore, reducing tobacco use and alcohol consumption and increasing the intakes of fruit and fish can reduce the risk for oral cancer to some extent.

Association of single nucleotide polymorphisms of TBX5 gene and environmental exposure index with susceptibility to oral cancer / 中华预防医学杂志

Objective@#To explore the association of TBX5 polymorphisms and environmental exposure index with susceptibility to oral cancer.@*Methods@#A case-control study was conducted to collect 300 oral cancer patients hospitalized in the Department of Oral and Maxillofacial Surgery, the First Affiliated Hospital of Fujian Medical University from September 2010 to December 2016. A total of 445 non-tumor patients were selected as the control group. Questionnaires were used to collect the information of all subjects and 5 ml peripheral blood was collected to detect single nucleotide polymorphisms (SNPs) of the rs10492336 locus of TBX5 gene. According to the environmental exposure index score, subjects were divided into two groups, low risk group (0-2.31) and high risk group (2.32-11.76). To analyze the association of TBX5 gene rs10492336 SNPs, environmental exposure index and oral cancer and its interactions.@*Results@#The age of all subjects in the case group and control group were (56.19±13.10) years and (54.56±12.48) years old. Compared with CC genotype, the OR (95%CI) values of the co-dominant genetic model AC genotype and the dominant genetic model AC+AA genotype were 0.69 (0.49-0.98) and 0.70 (0.51-0.97), respectively. Compared with the low risk group, the OR (95%CI) risk of oral cancer in the high risk group was 3.72 (2.55-5.43). The results of gene-environment interaction analysis showed that compared with the group with CC genotype and high risk of environmental exposure index, the OR (95%CI) value of oral cancer in the group with AC+AA genotype and low risk of environmental exposure index was 0.18(0.10-0.31). Furthermore there was a multiplicative interaction between rs10492336 SNPs and environmental exposure index (β=-0.405, P<0.001).@*Conclusion@#This study suggests that the TBX5 gene rs10492336 SNPs and environmental exposure index were associated with oral cancer. And there was a multiplication interaction between rs10492336 SNPs and environmental exposure index.

A novel prognostic index for oral cancer in Fujian province / 中华流行病学杂志

Objective To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC).Methods From January 2004 to June 2016,a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian.The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC.All the patients were randomly divided into two groups:modeling group (modeling dataset,n =318) and validation group (validation dataset,n =316).Randomization was carried out by using computer-generated random numbers.In the modeling dataset,survival rates were calculated using Kaplan-Meier method and compared using the log-rank test.Cox regression model was used to estimate the hazard ratio (HRs) and 95％ confidence intervals (CIs) of prognosis factors.An PI for OSCC patients prognostic prediction model was developed based onβ value of each significant variable obtained from the multivariate Cox regression model.Using the tertile analysis,patients were divided into high-risk group,moderate-risk group,and low-risk group according to the PI,the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability.Results Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22,95％ CI:1.45-3.39),poor oral hygiene (HR=2.12,95％ CI:1.27-3.54),first diagnosis of lymph node metastasis (HR=5.78,95％CI:3.60-9.27),TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43,95％CI:1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53,95％CI:1.60-4.01) were the risk factors influencing the prognosis of OSCC.The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80,0.700 2 and 1 150.47,0.737 3).Conclusion Age,poor oral hygiene,first diagnosis of lymph node metastasis,TNM stage and histological grade were factors associated with the prognosis of OSCC,and the PI model has a certain significance in the clinical treatment of OSCC.

A novel prognostic index for oral cancer in Fujian province / 中华流行病学杂志

Objective To explore the survival factors and construct a prognostic index (PI) for oral squamous cell carcinoma (OSCC).Methods From January 2004 to June 2016,a total of 634 patients with pathologically confirmed OSCC were recruited in a hospital of Fujian.The clinical and follow-up data of all the patients with pathologically confirmed OSCC were collected to identify the factors influencing the prognosis of OSCC.All the patients were randomly divided into two groups:modeling group (modeling dataset,n =318) and validation group (validation dataset,n =316).Randomization was carried out by using computer-generated random numbers.In the modeling dataset,survival rates were calculated using Kaplan-Meier method and compared using the log-rank test.Cox regression model was used to estimate the hazard ratio (HRs) and 95％ confidence intervals (CIs) of prognosis factors.An PI for OSCC patients prognostic prediction model was developed based onβ value of each significant variable obtained from the multivariate Cox regression model.Using the tertile analysis,patients were divided into high-risk group,moderate-risk group,and low-risk group according to the PI,the Akaike information criterion (AIC) and Harrell's c-statistic (C index) were used to evaluated the model's predictability.Results Results from the multivariate Cox regression model indicated that aged ≥55 years (HR=2.22,95％ CI:1.45-3.39),poor oral hygiene (HR=2.12,95％ CI:1.27-3.54),first diagnosis of lymph node metastasis (HR=5.78,95％CI:3.60-9.27),TNM stage Ⅲ-Ⅳ (stage Ⅰ as reference) (HR=2.43,95％CI:1.10-5.37) and poor differentiation (well differentiation as reference) (HR=2.53,95％CI:1.60-4.01) were the risk factors influencing the prognosis of OSCC.The PI model had a high predictability in modeling group and validation group (AIC and C index were 1 205.80,0.700 2 and 1 150.47,0.737 3).Conclusion Age,poor oral hygiene,first diagnosis of lymph node metastasis,TNM stage and histological grade were factors associated with the prognosis of OSCC,and the PI model has a certain significance in the clinical treatment of OSCC.

Pickled food, fish, seafood intakes and oral squamous cell carcinoma: a case-control study / 中华预防医学杂志

Objective@#To investigate the effects between fish, seafood and pickled food intakes on oral squamous cell carcinoma (OSCC).@*Methods@#A case-control study was carried out in Fujian area during September 2010 to December 2016, in which 604 newly diagnosed primary OSCC cases confirmed by pathological diagnosis were collected from hospital and 1 343 control subjects were enrolled from community and healthy hospital population. Demographic data, history of smoking drinking and tea drinking, oral hygiene status and dietary behaviors (fish, seafood and pickled food intakes) were collected by in-person interviews using a standard questionnaire.Using unconditional logistic regression to estimate adjusted odds ratios (ORs) and corresponding 95% confidence intervals (CIs) to assess the effects of fish, seafood and pickled food intakes on OSCC. Analysis stratified by smoking, alcohol drinking and bad prosthesis to explore the possible difference in association between subgroups. Multiplicative interactions and additive interactions between fish and bad prosthesis, seafood and alcohol drinking, pickled food and bad prosthesis were assessed by unconditional logistic regression, relative excess risk due to interaction (RERI), attributable proportion due to interaction (AP) and synergy index (S).@*Results@#The average age of case group and control group were separately (58.69±13.92) years old and (59.27±11.37) years old (χ2=4.75, P=0.191). The people whose fish and seafood intakes ≥3 times/week had the lower risk of OSCC, the adjusted OR (95%CI) values were 0.63 (0.52-0.77) and 0.51 (0.41-0.64); The stratified analysis indicated that the people having bad prosthesis had the lower risk of OSCC if they eating fish ≥3 times/week, and the adjusted OR (95%CI) values was 0.53 (0.39-0.71); the people having bad prosthesis had the higher risk of OSCC if they eating pickled food ≥3 times/week, the adjusted OR (95%CI) values was 1.37 (1.02-1.88). Regularly eating seafood can decrease the risk of OSCC for non-smokers, smokers, non-drinkers, drinkers, people without bad prosthesis and had bad prosthesis, the adjusted OR (95%CI) values were 0.49 (0.36-0.68), 0.52 (0.37-0.73), 0.41 (0.31-0.55), 0.77 (0.51-0.96), 0.49 (0.36-0.67), 0.59 (0.42-0.83). Crossover analysis showed fish and bad prosthesis exist multiplication interaction relationship (adjusted OR=0.66, 95%CI: 0.44-0.97) and additional interaction relationship (RERI=-0.81, 95%CI:-1.43--0.19; AP=-0.76, 95%CI:-1.35--0.17; S=0.08, 95%CI: 0.01-0.98); pickled food and bad prosthesis exist multiplication interaction relationship (adjusted OR=1.63, 95%CI: 1.06-2.51) and addition interaction relationship (RERI=0.65, 95%CI:0.08-1.22; AP=0.36, 95%CI:0.10-0.62; S=5.19, 95%CI:1.32-54.49).@*Conclusion@#Reducing the consumption of pickled food, quitting smoking and limiting alcohol consumption, and regularly eating fish and seafood can prevent the occurrence of OSCC.

A case-control study: association between oral hygiene and oral cancer in non-smoking and non-drinking women / 中华预防医学杂志

Objective@#To evaluate the influence of oral hygiene on risk of oral cancer in non-smoking and non-drinking women.@*Methods@#From September 2010 to February 2016, 242 non-smoking and non-drinking female patients with pathologically confirmed oral cancer were recruited in a hospital of Fuzhou, and another 856 non-smoking and non-drinking healthy women from health examination center in the same hospital were selected as control group. Five oral hygiene related variables including the frequency of teeth brushing, number of teeth lost, poor prosthesis, regular dental visits and recurrent dental ulceration were used to develop oral hygiene index model. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95%CI). The area under the receiver operating characteristic curve (AUROC) was used to evaluate the predictability of the oral hygiene index model. Multivariate logistic regression model was used to analyze the association between oral hygiene index and the incidence of oral cancer.@*Results@#Teeth brushing <2 twice daily, teeth lost ≥5, poor prosthesis, no regular dental visits, recurrent dental ulceration were risk factors for the incidence of oral cancer in non-smoking and non-drinking women, the corresponding OR (95%CI) were 1.50 (1.08-2.09), 1.81 (1.15-2.85), 1.51 (1.03-2.23), 1.73 (1.15-2.59), 7.30 (4.00-13.30), respectively. The AUROC of the oral hygiene index model was 0.705 9, indicating a high predictability. Multivariate logistic regression showed that the oral hygiene index was associated with risk of oral cancer. The higher the score, the higher risk was observed. The corresponding OR (95%CI) of oral hygiene index scores (score 1, score 2, score 3, score 4-5) were 2.51 (0.84-7.53), 4.68 (1.59-13.71), 6.47 (2.18-19.25), 15.29 (5.08-45.99), respectively.@*Conclusion@#Oral hygiene could influence the incidence of oral cancer in non-smoking and non-drinking women, and oral hygiene index has a certain significance in assessing the combined effects of oral hygiene.

Effect of tea on oral cancer in nonsmokers and nondrinkers: a case-control study / 中华预防医学杂志

<p><b>UNLABELLED</b>OBJECTIVE To investigate the effect of tea on oral cancer in nonsmokers and nondrinkers.</p><p><b>METHODS</b>A case-control study were performed between September 2010 and January 2015 including 203 oral cancer cases in nonsmokers and nondrinkers with pathologically confirmed and 572 community controls. The related information included socio-demographic characteristics, detailed information on tobacco smoking and alcohol and tea consumption, personal medical history, family history of cancer, and occupational history were collected from all subjects. Unconditional logistic regression analysis was used to calculate the odds ratios (OR) and 95% confidence intervals (95% CI) to examine the effect of tea on oral cancer and to assess multiplicative interactions between tea and passive smoking. We also stratified by age, sex, residence, and passive smoking to explore possible difference in association between subgroups. Additive interactions between tea and passive smoking were assessed using relative excess risk due to interaction (RERI), attributable proportion (AP), and synergy index (SI).</p><p><b>RESULTS</b>Compared with non-tea drinkers, tea consumption (OR = 0.52, 95% CI: 0.34-0.81), age of tea drinking initiation (years) ≥ 18 (OR = 0.54, 95% CI: 0.34-0.85), duration of tea consumption (years) < 20 (OR = 0.49, 95% CI: 0.27-0.90), duration of tea consumption (years) ≥ 20 (OR = 0.55, 95% CI: 0.32-0.95), average daily tea consumed < 700 ml (OR = 0.52, 95% CI: 0.32-0.86), moderate concentration of tea consumed (OR = 0.56, 95% CI: 0.32-0.96), weak concentration of tea consumed (OR = 0.35, 95% CI: 0.16-0.77), drinking green-tea (OR = 0.48, 95% CI: 0.28-0.82) and drinking moderate temperature of tea (OR = 0.55, 95% CI: 0.31-0.98) could reduce the risk of oral cancer; Stratified analysis indicated the protective effects of tea drinking on female (OR = 0.53, 95% CI: 0.30-0.94), age < 60 years old (OR = 0.53, 95% CI: 0.29-0.97), live in the urban (OR = 0.38, 95% CI: 0.20-0.69) and no passive smoking (OR = 0.47, 95% CI: 0.25-0.86) population with nonsmoking and nondrinking was more obvious; Crossover analysis showed tea and passive smoking did not exist multiplication interaction relationship (OR = 0.95, 95% CI: 0.41-2.20) and addition interaction relationship (RERI = -0.15, 95% CI: -0.92-0.62;AP = -0.16, 95% CI: -1.06-0.73; SI = -0.18, 95% CI: -1.44-0.87).</p><p><b>CONCLUSION</b>Tea consumption, age of tea drinking initiation, duration of tea consumption, average daily tea consumed, concentration of tea consumed, types of tea and temperature of tea might have impact on the incidence of oral cancer in nonsmokers and nondrinkers to a certain extent.</p>

Association between oral hygiene, chronic diseases, and oral squamous cell carcinoma / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the association between oral hygiene, chronic diseases, and oral squamous cell carcinoma.</p><p><b>METHODS</b>We performed a case-control study with 414 cases and 870 controls in Fujian during September 2010 to January 2015. Patients were newly diagnosed oral squamous cell carcinoma cases according to the pathologic diagnoses, control subjects were enrolled from community population. Epidemiological data were collected by in-person interviews using a standard questionnaire. The contents of the questionnaire included demography character, history of tobacco smoking and alcohol drinking, dietary habits, oral hygiene status, family history of cancer, etc. Using unconditional logistic regression analysis to estimate adjusted odds ratios (OR) and corresponding 95% confidence intervals (CI) for oral hygiene and chronic diseases. We also stratified by sex, smoking and drinking to explore possible difference in association between subgroups.</p><p><b>RESULTS</b>The multivariate logistic regression analysis indicated that number of teeth (20-27 and < 20), bad prosthesis, recurrent oral ulceration were the risk factors of oral squamous cell carcinoma, the adjusted OR (95% CI) values were 2.01 (1.49-2.73), 3.51 (2.39-5.15), 2.33 (1.79-3.04), 3.96 (2.11-7.44), respectively; brushing tooth once per bay, brushing tooth more than once per day, regular oral health examination at least 5 years per time were the protective factors of oral squamous cell carcinoma, the adjusted OR (95% CI) values were 0.24 (0.13-0.43), 0.13 (0.07-0.24), 0.37 (0.26-0.53), respectively. The stratification analysis indicated that recurrent oral ulceration could increase the risk of oral squamous cell carcinoma for non-smokers and non-drinking, the adjusted OR (95% CI) value was 5.21 (2.42-11.18) and 4.71 (2.37-9.36); and a risky effect of hypertension on risk of oral squamous cell carcinoma was observed for non-smokers and non-drinking, the adjusted OR (95% CI) values were 1.70 (1.10-2.61) and 1.58 (1.07-2.34).</p><p><b>CONCLUSIONS</b>Oral hygiene and chronic diseases could affect the incidence of oral squamous cell carcinoma.</p>

Influencing factors for oral-maxillofacial benign tumors: a case-control study / 中华预防医学杂志

<p><b>OBJECTIVE</b>To investigate the clinical influence factors of oral-maxillofacial benign tumors.</p><p><b>METHODS</b>We conducted a case-control study with 113 cases newly diagnosed primary oral-maxillofacial benign tumors and 584 cases controls from a hospital in Fujian from September 2010 to January 2015. Epidemiological data were collected by in-person interviews using a standard questionnaire. The contents of the questionnaire included demography character, history of tobacco smoking and alcohol drinking, dietary habits, oral hygiene status, family history of cancer, etc. Unconditional logistic regression was used to research the relationship between the factors and oral-maxillofacial benign tumors.</p><p><b>RESULTS</b>Multivariable analysis showed that risk factors of oral-maxillofacial benign tumors included: cigarette smoking index above 1 000, passive smoking before the age of 18, age of wearing bad prosthesis between 33 to 55 years old and high blood pressure; the corresponding OR (95% CI) values were 14.63 (3.88-55.13), 2.34 (1.19-4.62), 2.35 (1.17-4.73), 3.46 (1.71-7.00), respectively; Protective factors included: regularly intake of meat above 1 time/day, fruits, health care products and vitamin tablets, brushing teeth above 1 time per day and oral examination above 5 years/time, the corresponding OR (95% CI) values were 0.22 (0.07-0.70), 0.18 (0.08-0.41), 0.32 (0.11-0.88), 0.22 (0.07-0.73), 0.28 (0.16-0.48), 0.28 (0.13-0.60), respectively.</p><p><b>CONCLUSION</b>Abstinence from tobacco smoking, reduce passive smoking before the age of 18, regularly intake of meat, fruits, health care products and vitamin tablets, and oral examination at regular time might have impact on the incidence of oral-maxillofacial benign tumors to a certain extent.</p>