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Review
. 2015 Oct 24:15:782.
doi: 10.1186/s12885-015-1813-9.

Prognostic significance of Epstein-Barr virus infection in gastric cancer: a meta-analysis

Xuechao Liu  1   2 , Jianjun Liu  3   4 , Haibo Qiu  5   6 , Pengfei Kong  7   8 , Shangxiang Chen  9   10 , Wei Li  11   12 , Youqing Zhan  13   14 , Yuanfang Li  15   16 , Yingbo Chen  17   18 , Zhiwei Zhou  19   20 , Dazhi Xu  21   22 , Xiaowei Sun  23   24
Affiliations
Review

Prognostic significance of Epstein-Barr virus infection in gastric cancer: a meta-analysis

Xuechao Liu et al. BMC Cancer. .

Abstract

Background: The prognostic significance of Epstein-Barr virus (EBV) infection in gastric cancer (GC) remains unclear. Recently, a number of studies have investigated the association between EBV infection and the prognosis of GC with controversial results. We therefore conducted a meta-analysis to assess its prognostic significance.

Methods: PubMed and EMBASE were searched for studies up to October 1, 2014. We investigated the association between EBV infection with survival in patients with GC. The pooled hazard ratio (HR) and its 95% confidence interval (CI) were calculated to evaluate risk.

Results: A final analysis of 8,336 patients with GC from 24 studies was performed. Our analysis results indicated that the pooled HR was 0.67 (95% CI: 0.55-0.79; Z = 11.18, P < 0.001). Subgroup analyses stratified by region revealed that the protective role of EBV infection only remained in the Asian population (HR: 0.62, 95% CI: 0.48-0.75; P < 0.001). When stratified by study quality and statistical methodology, the protective role could also be identified in high quality studies (HR: 0.67, 95% CI: 0.55-0.79) and in univariate analysis studies (HR: 0.62, 95% CI: 0.50-0.74). There was no evidence of significant heterogeneity and publication bias.

Conclusions: The presence of EBV has a favorable impact on GC patient's survival, especially in an Asian population. Future updated studies, especially large-scale randomized controlled studies stratified by region, are warranted as validation studies.

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Figures

Fig. 1
Fig. 1
Flow chart of articles selection for meta-analysis. Abbreviations: LELC, lymphoepithelioma-like carcinoma
Fig. 2
Fig. 2
The forest plot demonstrates the effect sizes and 95 % confidence intervals (CIs) for each study and overall. Hazard ratios (HRs) with corresponding 95 % CIs of individual studies and pooled data for the association between Epstein-Barr virus-positive gastric cancer and overall survival. The forest plot demonstrates the effect sizes and 95 % CIs for each study and overall
Fig. 3
Fig. 3
Funnel Plots for Studies. Funnel plots showing the relationship between the effect size of individual studies (standard error, horizontal axis) and the precision of the study estimate (hazard ratios for overall survival, vertical axis) for EBV
Fig. 4
Fig. 4
Publication bias plot for overall survival (a) Egger’s publication bias plot (b) Begg’s funnel plot
See this image and copyright information in PMC

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