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. 2022 May 12:10:905690.
doi: 10.3389/fpubh.2022.905690. eCollection 2022.

U-Shaped Relationship of Rare Earth Element Lanthanum and Oral Cancer Risk: A Propensity Score-Based Study in the Southeast of China

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U-Shaped Relationship of Rare Earth Element Lanthanum and Oral Cancer Risk: A Propensity Score-Based Study in the Southeast of China

Fa Chen et al. Front Public Health. .

Abstract

As an important rare earth element (REE) extensively applied to industry, agriculture, and medicine, lanthanum (La) has attracted a host of health concerns. This study aimed to explore the relationship between La exposure and the risk of developing oral cancer through a case-control study with a large sample size. Serum La levels of 430 oral cancer patients and 1,118 healthy controls were detected by inductively coupled plasma mass spectrometry (ICP-MS). The association of La level with the risk of oral cancer was assessed in two ways: (1) as a continuous scale based on restricted cubic splines (RCS); (2) as a priori defined centile categories using multivariate logistic regression model, based on propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). The RCS revealed a non-linear U-shaped relationship between serum La and oral cancer risk. Serum La deficiency or excess was associated with an increased risk of oral cancer. When the La level was analyzed as a categorical variable, a similar U-shaped association was observed. Of note, compared to those with La concentrations of 0.243-0.341 μg/L (reference quantiles, 41st-60th), the risk was increased in those with the lower or higher quantiles (0.132-0.242 μg/L vs. 0.243-0.341 μg/L: OR = 1.80, 95%CI: 1.07-3.02; 0.342-0.497 μg/L vs. 0.243-0.341 μg/L: OR = 2.30, 95%CI: 1.38-3.84). The results were generally consistent with the PSM and IPTW analyses. This preliminary study provides strong evidence that there was a U-shaped relationship between serum La levels and oral cancer risk. Much additional work is warranted to confirm our findings.

Keywords: lanthanum; oral cancer; propensity score analyses; rare earth elements; risk assessment.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of serum La in case and control1 groups, for visualization purposes, we log2 transformed the measured la concentrations. ***P < 0.001 by Wilcoxon rank sum test.
Figure 2
Figure 2
Multivariable-adjusted restricted cubic splines (RCS) according to levels of La on a continuous scale. Solid red lines are multivariable-adjusted odd ratios, with red shading indicating 95% confidence intervals derived from restricted cubic spline regressions with five knots. Reference lines for no association are indicated by the dash lines at an odd ratio of 1.0. The blue regions represent the histogram of the distribution of La. And the solid red dot indicates the concentration of La with the lowest risk of oral cancer. Analyses were adjusted for age, gender, occupation, education level, BMI, residence, family history of cancer, smoking, alcohol and tea drinking, as well as intake frequency of red meat, fish, seafood, vegetables, and fruits.
Figure 3
Figure 3
Comparison of the distribution of matching factors between cases and controls before and after matching. Group differences were assessed using standardized mean differences (SMD), with an SMD value of 0.1 considered balanced.
Figure 4
Figure 4
Odd ratios for oral cancer according to categories of levels of La in the total study population, 1:1 PSM population, and IPTW population. (a) Calculated from multivariable logistic regression models, with adjustment for age, gender, occupation, education level, BMI, residence, family history of cancer, smoking, alcohol and tea drinking, as well as intake frequency of red meat, fish, seafood, vegetables, and fruits. (b,c) Calculated from conditional logistic regression models.

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