Detection of human papillomavirus in sinonasal carcinoma: systematic review and meta-analysis

Abstract

Since first suggested (in 1983), the etiological role for human papillomavirus (HPV) in sinonasal carcinomas has been subject to constantly increasing interest. To perform systematic review and formal meta-analysis of the literature reporting on HPV detection in sinonasal squamous cell carcinomas (SCC), literature was searched through May 2012. The effect size was calculated as event rates (95% CI), with homogeneity testing using Cochran Q and I(2) statistics. Meta-regression was used to test the impact of study-level covariates (HPV detection method, geographic origin, papilloma type) on effect size, and potential publication bias was estimated using funnel plot symmetry. Thirty-five studies were eligible, covering 492 sinonasal SCCs from different geographic regions. Altogether, 133 (27.0%) cases tested HPV-positive; effect size 0.305 (95% CI, 0.260-0.355; fixed effects model), and 0.330 (95% CI, 0.249-0.423; random effects model. In meta-analysis stratified by (i) HPV detection technique and (ii) geographic study origin, the between-study heterogeneity was significant only for the latter; P = .526, and P = .0001, respectively. In maximum likelihood meta-regression, HPV detection method (P = .511) and geographic origin of the study (P = .812) were not significant study-level covariates. Some evidence for publication bias was found only among polymerase chain reaction-based studies and among studies from Europe and North America but with negligible effect on summary effect size estimates. In sensitivity analysis, all meta-analytic results were robust to all one-by-one study removals. In formal meta-regression, the variability in HPV detection rates reported in sinonasal SCCs was not explained by the HPV detection method or geographic origin of the study.