Comment on “Infectious pathogens and risk of esophageal, gastric and duodenal cancers and ulcers in China: A case‐cohort study”

Abstract

We read with great interest that Kartsonaki et al. conducted a casecohort study based on the China Kadoorie Biobank study and reported a high seroprevalence of Epstein-Barr virus (EBV) up to 99.8%. 1 This study found that EBV seropositivity was not associated with non-cardia gastric cancer, and was inversely associated with cardia gastric cancer. This needs to be interpreted with caution due to the fairly high seroprevalence. Similarly, our previous systematic review found that the EBV seropositivity of EBV-encoded small RNA (EBER) IgG, VCA IgG, VCA IgA, EA IgG, EA-D IgG, and EA-R IgG were diverse, but generally comparable between incident gastric cancer patients and healthy controls. 2 Therefore, we hypothesize that the detection of EBV nucleic acids in gastric cancer tissue, but not in noncancer tissue, could substantially evidence the causal role of EBV in infection-attributable gastric carcinogenesis, rather than serology of EBV. Namely, the detection of EBV in stomach mucosa might be better to predict infection-attributable gastric cancer.