Abstract
BACKGROUND: Most patients who undergo esophagectomy for esophageal cancer develop tumor recurrence and die within 5 years of surgery. An impact of preoperative dental status on survival in this patient group has been suggested but remains uncertain. METHODS: This national Swedish cohort study included 871 patients who underwent esophagectomy for esophageal cancer (adenocarcinoma or squamous cell carcinoma) between 2011 and 2020 and were followed up until 2024. The exposure was the number of remaining teeth, based on dentist visits within 5 years before the esophagectomy, categorized into five (quintiles) and 10 (deciles) groups. The main outcome was all-cause 5-year mortality. Data were retrieved from medical records and national complete registries. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for age, sex, comorbidity, tumor histology, neoadjuvant therapy, education level, and pathological tumor stage. RESULTS: There were no statistically significant associations between the number of remaining teeth and the risk of all-cause 5-year mortality, independent of the categorization of the number of teeth. The HR was 1.13 (95% CI 0.85-1.51) comparing the lowest quintile of remaining teeth (n = 0-19) with the highest quintile (n = 29-32), and the HR was 0.98 (95% CI 0.64-1.52) comparing the lowest decile of remaining teeth (n = 0-10) with the highest decile (n = 31-32). There were no statistically significant associations in any of the subgroup analyses of age, comorbidity, or education. CONCLUSION: This study did not identify any association between the number of remaining teeth and the risk of 5 year mortality in patients who underwent esophagectomy for esophageal cancer.