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Meta-Analysis
. 2020 Jul;11(7):e00201.
doi: 10.14309/ctg.0000000000000201.

Associations Between Gastric Cancer Risk and Virus Infection Other Than Epstein-Barr Virus: A Systematic Review and Meta-analysis Based on Epidemiological Studies

Hui Wang  1 , Xiao-Long Chen  1 , Kai Liu  1 , Dan Bai  1 , Wei-Han Zhang  1 , Xin-Zu Chen  1   2   3 , Jian-Kun Hu  1 ; SIGES research group
Affiliations
Meta-Analysis

Associations Between Gastric Cancer Risk and Virus Infection Other Than Epstein-Barr Virus: A Systematic Review and Meta-analysis Based on Epidemiological Studies

Hui Wang et al. Clin Transl Gastroenterol. 2020 Jul.

Abstract

Introduction: Besides Helicobacter pylori and Epstein-Barr virus, other viruses might play potential roles in gastric carcinogenesis. This systematic review and meta-analysis was conducted to compare the prevalence of the viruses between gastric cancer (GC) and any controls.

Methods: Comprehensive literature was searched up to January 25, 2019, and search was updated on April 6, 2020. The studies that compared the prevalence of viruses other than Epstein-Barr virus between GC and healthy or nonmalignant controls were eligible. Stata 12.0 software was used for heterogeneity tests and meta-analyses. Meanwhile, subgroup analysis, sensitivity analysis, and publication bias evaluation were performed where applicable. The power (1-β) was estimated by the PASS 11 software for each individual study.

Results: A total of 41 eligible studies were included, concerning 11 kinds of viruses. Prevalence were significantly higher in GC for hepatitis B virus (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.11-1.75), human cytomegalovirus (OR = 2.25, 95% CI 1.14-4.43), human papillomavirus (HPV) (OR = 1.63, 95% CI 1.05-2.54), and John Cunningham virus (OR = 2.52, 95% CI 1.26-5.04). In subgroup analyses, HPV-16 infection was significantly associated with GC (OR = 2.42, 95% CI 1.00-5.83).

Discussion: This study demonstrated that hepatitis B virus, human cytomegalovirus, HPV, and John Cunningham virus were more prevalent in GC. However, the causal relationship between their infection and risk of GC remains inconclusive, and further investigations are required.

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Conflict of interest statement

Guarantor of the article: Xin-Zu Chen, MD, PhD, and Jian-Kun Hu, MD, PhD, FRCS, gave final approval of the version to be published.

Specific author contributions: Hui Wang and Xiao-long Chen, MD, PhD, contributed equally to this work. H.W., X.-L.C., X.-Z.C., and J.-K.H.: made substantial contributions to conception and design of the study. H.W., X.-L.C., K.L., D.B., and W.-H.Z.: participated in this systematic review for literature search, selection, quality assessment, and data extraction. H.W. and X.-L.C.: drafted this systematic review. H.W., X.-L. C., and J.-K.H.: gave critical revision for important intellectual content. K.L., and W.-H.Z., X.-Z.C., and J.K.H: participated in critical revision for important intellectual content.

Financial support: (1)The 1•3•5 Project for Disciplines of Excellence, West China Hospital, Sichuan University (No. ZY2017304); (2) National Natural Science Foundation of China, (No. 81702366); (3) Sichuan Science and Technology Program (No.2019YFS0255); (4) Wu Jieping Medical Foundation (No. 320.2710.1815, No.320.2710.1865).

Potential competing interests: None to report.

Ethics and dissemination: The meta-analysis was not submitted for any ethical approval due to the literature-based nature.

Registration: The present systematic review (registration number: CRD42015029703) was registered in the PROSPERO International Prospective Register of Systematic Reviews supported by the National Institute for Health Research of the National Health Service (NHS), UK (85).

Figures

Figure 1.
Figure 1.
The flowchart of the literature search.
Figure 2.
Figure 2.
The forest plots of the comparison on virus prevalence between patients with gastric cancer and any controls after excluding subjects with known H. pylori and EBV positive: (a) the forest plot for HBV; (b) HCMV: Jin [1–5]: different sequences of HCMV genome were detected; Zhang [1–2]: IgG or IgM was detected; (c) the forest plot for HPV: Kamangar [1–3]:different subtypes of HPV were investigated; Ma [1–2]:different test methods were used; and (d) the forest plot for JCV: Jang [1–2]: different test methods were used; Murai [1–3]: different sequences of JCV genome were detected by Southern blot; Murai [4]: T-Ag were detected by immunohistochemistry; Shin [1–3]: different sequences of JCV genome were detected. CI, confidence interval; EBV, Epstein-Barr virus; HCMV, human cytomegalovirus; HPV, human papillomavirus; JCV, John Cunningham virus; OR, odds ratio; T-Ag, transforming antigen.
Figure 3.
Figure 3.
Sensitivity analysis of the meta-analysis: (a) HBV; (b) HCMV; (c) HPV; and (d) JCV. CI, confidence interval; HBV, hepatitis B virus; HCMV, human cytomegalovirus; JCV, John Cunningham virus.
See this image and copyright information in PMC

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