Abstract
A number of epidemiological studies have suggested a positive association between periodontal diseases and oro-digestive cancers, including liver cancer. The purpose of the present systematic review was to analyze the current evidence regarding the potential association between periodontitis and/or tooth loss and the risk of liver cancer. A comprehensive search of PubMed, Scopus and Web of Science databases was conducted in August 2019. The inclusion criteria comprised all observational studies that assessed the relationship between periodontitis or tooth loss and liver cancer. Case reports, animal studies, experimental studies, and reviews were excluded. Due to great heterogeneity among the included studies, no meta-analysis was conducted. Six studies (five prospective cohorts and one case-control) comprising 619,834 subjects (including 916 liver cancer cases) were included. The studies were conducted in the United States, Europe, and Asia. Three large-scale cohort studies reported a positive association between periodontitis or tooth loss and the risk of liver cancer. One case-control study found some association between liver cancer and loss of 12-23 teeth, but such association was not replicated in patients with greater number of tooth loss. Contrarily, two studies failed to report any association between periodontitis and/or tooth loss and the risk of liver cancer. The available evidence suggests a possible link between tooth loss/periodontitis and the risk of liver cancer. However, the evidence is not conclusive enough, a fact that drives to conduct more, well-designed, prospective cohort studies to further explore the potential association between periodontitis and the risk of liver cancer.
Highlights
Liver cancer is the sixth most common cancer and the fourth leading cause of cancer mortality worldwide, accounting for an estimated 841,000 new cases and 782,000 deaths annually (Bray, Ferlay et al 2018)
The PECO research question was: Is tooth loss or periodontitis a risk factor for liver cancer? Eligibility criteria The eligibility criteria were as follows: all observational studies that assessed the relationship between tooth loss or periodontitis and the risk liver cancer in humans
The results showed that subjects in the highest quartile of age-specific tooth loss had an increased risk of liver cancer, with varied results according to gender
Summary
Liver cancer is the sixth most common cancer and the fourth leading cause of cancer mortality worldwide, accounting for an estimated 841,000 new cases and 782,000 deaths annually (Bray, Ferlay et al 2018). The main risk factors for liver cancer include hepatitis B virus, hepatitis C virus, heavy alcohol consumption, tobacco use, aflatoxin exposure, obesity, and diabetes mellitus (Bray, Ferlay et al 2018). These factors cause chronic liver inflammation, which may progress at the absence of treatment to more severe chronic forms of hepatic inflammation (cirrhosis), and eventually liver cancer (McGlynn, Petrick et al 2015). Periodontitis, a highly prevalent disease worldwide, is a chronic, destructive, inflammatory disease of the teeth-supporting tissues including gingiva, alveolar bone and periodontal ligament (Meyle and Chapple 2015, Papapanou and Susin 2017). The present systematic review aimed to assess the potential association between tooth loss or periodontitis and the risk of liver cancer
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