钪与口腔癌的关联：基于倾向性评分匹配法的病例对照研究
Scandium and oral cancer: A case-control study based on propensity score matching
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摘要:
背景 目前国内外鲜见钪（Sc）与口腔癌发病风险关联的报道，且微量元素与肿瘤关系的研究也多为未匹配组间协变量的回顾性研究。
目的 运用倾向性评分匹配法（PSM）均衡组间协变量，探讨Sc与口腔癌发病风险之间的关联。
方法 采用病例对照研究方法，收集2010年1月-2018年11月，于福建医科大学附属第一医院口腔颌面外科经手术后病理确诊的390例口腔癌新发患者及同期社区体检1 219例健康人群信息。采用PSM 1：1最邻近匹配法，以病例为基准组，匹配病例与健康对照，平衡两组间一般人口学特征与生活方式等，最终成功匹配300例病例与300例健康对照作为病例组和对照组，用于后续研究。用微波消解法消解血清样品，并通过电感耦合等离子体质谱法检测血清中Sc。利用
χ 2检验对匹配后病例组及对照组的一般人口学特征及生活方式各因素进行均衡性检验；应用Wilcoxon秩和检验比较病例组与对照组之间血清中Sc水平。同时，按对照组血清中Sc水平的三分位数将其分成低、中、高水平，采用条件logistic回归计算血清中Sc水平与口腔癌发病风险关系的OR 值及其95%CI 。另外，采用Cochran-Armitage趋势检验分析Sc水平与口腔癌发病风险之间的关系。结果 病例组Sc水平的
M （P 25~P 75）为5.56（3.71~6.94）μg·L-1，低于对照组Sc水平7.21（6.14~8.83）μg·L-1（P < 0.001）。条件logistic回归分析显示，血清中Sc水平与口腔癌的发病风险存在负相关，中水平组与高水平组的口腔癌发病风险均低于低水平组，其OR （95%CI ）分别为0.29（0.18~0.45）和0.14（0.08~0.25）。随着Sc水平的增高，口腔癌发病风险也随之降低（P 趋势 < 0.001）。结论 血清Sc水平越高，口腔癌的发病风险越低。
Abstract:Background Limited data on potential association between scandium (Sc) and the risk of developing oral cancer are available from both domestic and international sources, and studies on the relationship between trace elements and tumors are mainly retrospective without covariance matching.
Objective This study explores the association of Sc with oral cancer risk based on propensity score matching (PSM).
Methods The subjects in this case-control study consisted of 390 oral cancer patients who were histologically confirmed in the First Affiliated Hospital of Fujian Medical University between January 2010 and November 2018 and 1 219 cancer-free subjects who were community residents and ordered health examination. A 1:1 PSM was used to match the case group to the healthy control group for selected potential factors such as demographic characteristics and lifestyles, and 300 patients with oral cancer and 300 healthy controls were selected for final analysis. Serum samples were digested by microwave and detected for Sc concentrations by inductively coupled plasma mass spectrometry. The distributions of demographic characteristics and lifestyles between the case and control groups were compared by chi-square test. The difference in serum Sc between the cases and controls was assessed by Wilcoxon rank sum test. The odds ratios (
OR ) and corresponding 95% confidence intervals (95%CI ) for the association of serum Sc level with oral cancer risk using tertiles of serum Sc level of the control group were estimated by conditional logistic regression model. The association between Sc level and the risk of oral cancer was also analyzed by Cochran-Armitage trend test.Results The median (
P 25-P 75) of serum Sc concentration in the oral cancer patients5.56 (3.71-6.94) μg·L-1 was lower than that in the controls7.21 (6.14-8.83) μg·L-1 (P < 0.001). The results of conditional logistic regression model showed medium and high levels of serum Sc versus low level of serum Sc were associated with a decreased risk of oral cancer, and the adjustedORs were 0.29 (95%CI :0.18-0.45) and 0.14 (95%CI :0.08-0.25), respectively. The risk of oral cancer was decreased with the increase of serum Sc level (P trend < 0.001).Conclusion A higher serum Sc level is associated with a lower risk of oral cancer.
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