Independent Prognostic Value of Natural Tooth Count Versus Posterior Teeth Occlusion in Resected Pancreatic Cancer

Prognostic significance of preoperative patient-related factors, including oral health status, in pancreatic ductal adenocarcinoma (PDAC) remains unclear. We evaluated the association between preoperative factors-particularly oral health parameters-and long-term survival after curative PDAC resection.

Patients who underwent radical pancreatectomy for PDAC (2014-2022) were retrospectively analyzed. Preoperative factors, including oral health status (natural tooth count and posterior teeth occlusion), clinical characteristics, and immuno-nutritional markers, were assessed for their association with overall survival (OS). Multivariate models adjusted for established pathological and treatment-related prognostic variables were further analyzed.

Of 343 eligible patients, 339 underwent preoperative dental examinations; 135 had ≤ 20 teeth and 204 had ≥ 21 teeth. Patients with ≤ 20 teeth had significantly poorer OS (median survival: 39.1 vs. 60.7 months, p < 0.001). Posterior teeth occlusion was not associated with OS. In multivariate analysis of preoperative factors, natural tooth count was independently associated with OS (p = 0.003). This association remained significant after adjustment for established prognostic variables (p = 0.016), whereas other immuno-nutritional markers did not emerge as independent prognostic factors.

Post-PDAC resection, natural tooth count, but not posterior teeth occlusion, is independently associated with OS. Tooth count may reflect long-term host vulnerability and serve as a prognostic marker in PDAC patients.