Tooth count may predict survival after pancreatic cancer surgery

A study by researchers at Hiroshima University suggests that the number of natural teeth a person possesses could be a predictor of their survival following surgery for pancreatic ductal adenocarcinoma (PDAC), one of the deadliest forms of cancer. Oral health has been linked to overall health outcomes in various cancers, and previous research has identified connections between poor dental health and prognosis in colorectal and esophageal cancers.

The Hiroshima University team aimed to investigate whether oral health also played a role in how long patients lived after undergoing resection surgery for PDAC. The study included 339 patients who underwent radical pancreatectomy between 2014 and 2022 at Hiroshima University Hospital. Each patient underwent a dental examination before the surgery, and the researchers assessed oral health based on the number of natural teeth remaining and the status of occlusion in the premolars and molars.

The findings showed a significant difference in median overall survival based on the number of natural teeth. Patients with 21 or more natural teeth had a median overall survival of 60.7 months, while those with 20 or fewer teeth had a median survival of 39.1 months. This significant gap remained even after accounting for established prognostic factors such as tumor stage, lymph node metastasis, surgical margins, chemotherapy, and nutritional status.

One noteworthy discovery was that chewing function alone, determined by posterior teeth occlusion, did not independently influence survival. This implies that tooth loss may indicate more than just oral function; it could be an indicator of underlying chronic inflammation, frailty, nutritional status, lifestyle factors, and systemic vulnerabilities accumulated over the years. The researchers concluded, "The mouth may reflect the body's long-term resilience."

While the study was conducted at a single center and involved Japanese patients, the researchers acknowledge the need for further investigation in larger, multicenter studies involving diverse populations. They also plan to explore the potential link between oral bacteria, chronic inflammation, and pancreatic cancer progression.

The ultimate goal is to incorporate oral health assessment into personalized risk stratification and perioperative management for pancreatic cancer patients, moving beyond tumor biology as the sole determinant of prognosis.