Prevalence and Clinical Impact of Severe Periodontitis in Patients With Gastric Cancer

A potential link between periodontitis and the development of gastric cancer (GC) has been reported. However, its prevalence and impact on patients with GC remain unclear. This study investigated the association between periodontitis severity and clinical parameters, including Helicobacter pylori (H. pylori) infection and endoscopic findings, in patients with GC undergoing gastrectomy. This retrospective cohort study included 145 patients who underwent curative gastrectomy with perioperative oral care (2020-2023). Periodontal status was assessed using pocket probing depth (PPD), bone resorption, and remaining teeth. Severe periodontitis was defined as PPD ≥6 mm, horizontal bone resorption ≥33%, furcation involvement (class II/III), vertical bone resorption ≥3 mm, or <20 remaining teeth. Clinical variables were compared between no/mild and severe periodontitis groups. The median number of remaining teeth was 24; 65.5% of patients had ≥20 teeth. PPD ≥6 mm was observed in 29.4%, and gingival bleeding in 71.3%. Severe periodontitis was diagnosed in 64.8% of patients and was associated with older age (≥70 years; 70% vs. 39%, p<0.001), higher C-reactive protein (≥1.0 mg/dl; 10% vs. 0%, p=0.002), and lower albumin (<3.5 g/dl; 14% vs. 2%, p=0.009) levels. It was more common in patients with differentiated adenocarcinoma (p=0.005) and lymphatic invasion (p=0.006) but not significantly associated with H. pylori infection or endoscopic findings. Patients with GC have a high prevalence of severe periodontitis, linked to systemic inflammation, poor nutrition, and aggressive tumor characteristics, emphasizing the need for integrated periodontal care.