Periodontopathogenic bacteria have been increasingly implicated in the prognosis of colorectal cancer. Among these microorganisms, Fusobacterium nucleatum has been frequently detected in tumor tissues and associated with unfavorable clinical outcomes. However, observational evidence remains heterogeneous, and quantitative synthesis focusing specifically on survival outcomes is still limited. This systematic review and meta-analysis of observational cohort studies is aimed at evaluating the association between periodontopathogenic bacteria and survival outcomes in patients with colorectal cancer. Searches were performed in PubMed, Embase, Scopus, and Web of Science, covering the last 10 years. Only human cohort studies reporting adjusted estimates for survival-related outcomes were included. Data extraction and risk-of-bias assessment were independently performed by two reviewers, and meta-analyses were conducted using random-effects models. Five cohort studies met the eligibility criteria, four of which were included in the quantitative synthesis. The meta-analysis demonstrated a significant association between the presence of periodontopathogenic bacteria and poorer survival outcomes in colorectal cancer, with a pooled hazard ratio of 1.84 (95% CI: 1.38–2.46) and low observed statistical heterogeneity. This association was consistently observed for F. nucleatum. These findings suggest that periodontopathogenic bacteria, particularly F. nucleatum, may play an important role in colorectal cancer prognosis and could serve as potential prognostic biomarkers and emerging therapeutic targets.
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