Tooth Loss Predicts Long-Term Prognosis of Esophageal Cancer After Esophagectomy

Background Oral health is associated with various diseases, including cancer. Tooth loss is a simple and objective index of oral health. Objective The purpose of this study was to investigate the association between preoperative tooth loss and esophageal cancer prognosis after esophagectomy. Methods This study included 191 patients who underwent esophagectomy for esophageal cancer after perioperative dental evaluation and oral care at Kobe University Hospital from April 2011 to March 2016. Patients were divided into two groups: Group A (tooth loss < 7) and Group B (tooth loss >= 7). Three-year overall survival (OS) and multivariate analysis were performed, along with subgroup analysis for elderly patients (age >= 65 years). Results The 3-year OS rate was 68.1% in Group A (104 patients) and 49.2% in Group B (87 patients). Group A had significantly higher OS than Group B (p = 0.002), and there were no significant differences in sex and clinical T or N stage between the two groups. However, the mean age of Group A was younger than that of Group B (64.2 vs. 68.5 years; p = 0.0002). Among elderly patients, the 3-year OS rate was 68.2% in Group A (55 patients) and 45.1% in Group B (65 patients) [p = 0.003]. Multivariate analysis that included age demonstrated that tooth loss is an independent prognostic factor (hazard ratio 1.87, 95% confidence interval 1.22-2.87), in addition to clinical T stage and preoperative serum albumin. Conclusion Tooth loss is an independent prognostic factor for esophageal cancer after esophagectomy.