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Association Between Rare Earth Element Cerium and the Risk of Oral Cancer: A Case-Control Study in Southeast China

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This hospital-based case-control study measured serum cerium by ICP-MS in 324 oral cancer patients and 650 controls in Fujian Province, China. Cases had lower serum cerium than controls, and higher serum cerium was associated with lower odds of oral cancer after adjustment. Blood was drawn once after diagnosis, so the direction of the association cannot be established.

Key numbers

  • Serum cerium, median (25th to 75th percentile): cases 0.57 (0.21 to 3.02) µg/L; controls 2.27 (0.72 to 4.26) µg/L; difference P < 0.001 (Results, p. 5; abstract).
  • Serum cerium at or above the control median (2.27 µg/L) versus below: adjusted odds ratio 0.60 (95% CI 0.43 to 0.84) (Table 2, p. 3).
  • Per one-unit increase in serum cerium: odds ratio 0.90 (95% CI 0.84 to 0.96) (p. 5).
  • Stronger inverse associations in smokers (OR 0.46, 95% CI 0.27 to 0.79), drinkers (OR 0.50, 0.26 to 0.96), and those with limited leafy vegetable (OR 0.40, 0.22 to 0.71) or fish intake (OR 0.52, 0.33 to 0.83) (abstract, p. 1).
  • ICP-MS limit of detection 0.0003 µg/L; recovery of rare earth element standards 89.1% to 92% (p. 4).

Methods (brief)

Cases were newly diagnosed, histologically confirmed primary oral cancer patients aged 20 to 80 at one Fuzhou hospital; controls were frequency-matched people attending routine health checks. Fasting serum was microwave-digested and analyzed by ICP-MS (NexION 350X) with a human hair reference material, blanks and 12.5% duplicate samples. Unconditional logistic regression adjusted for demographic, smoking, drinking, family history and dietary factors.

Evidence fitness

Supports statements about measured serum cerium levels in adults in this part of China and an observed inverse association with oral cancer. It does not establish that cerium protects against cancer, does not identify the dietary or environmental source of serum cerium, and does not distinguish cerium oxidation states.

Limitations

Single post-diagnosis blood draw (reverse causation possible, as the authors note); hospital-based controls; dietary data from a broad frequency questionnaire; the authors could not determine cerium valence. Serum levels are not linked to food concentrations.

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