Association between periodontitis and hepatocellular carcinoma across different tumor stages

Hepatocellular carcinoma (HCC) is a malignant liver cancer. While periodontitis associates with many chronic liver diseases, oral health data of HCC patients remain limited. This study assessed dental/periodontal health differences across different stages and confirmed the association between periodontitis and HCC. 113 HCC patients and 30 healthy volunteers were enrolled. HCC patients were stratified by China Liver Cancer Staging (CNLC): Ⅰa, Ⅰb, Ⅱa, Ⅱb, Ⅲa, and Ⅲb. Biochemical tests and oral examinations data were collected at HCC patients’ admission and analyzed to their oral characteristics and explore correlations between periodontitis and various liver-related indicators. Compared with healthy individuals, HCC patients exhibited significantly increased periodontal probing depth (PD), gingival recession, clinical attachment loss (CAL), bleeding on probing (BOP), and higher tongue disease prevalence. Additionally, stage Ⅲb patients had the most severe periodontitis. Logistic regression identified PD, tooth loss, and BOP as HCC-associated factors. Correlation analysis showed that PD was significantly correlated with aspartate transaminase, alanine transaminase, fibrinogen, D-dimer, alpha-fetoprotein, and protein induced by vitamin K absence or antagonist-II. BOP was significantly correlated with aspartate transaminase, alkaline phosphatase, γ-glutamyl transpeptidase, activated partial thromboplastin time, and D-dimer (all P < 0.05). Periodontitis is associated with HCC. PD and BOP correlate with key HCC markers. These findings emphasize the relationship between periodontitis and HCC and highlights the need for interdisciplinary collaboration between dentistry and hepatology to optimize oral care and overall management of HCC patients. This study has been registered at Chinese Clinical Trial Registry (ChiCTR2400082256, March 25, 2024, https://www.chictr.org.cn/).