Evidence for the aetiology of human papillomavirus in oesophageal squamous cell carcinoma in the Chinese population: a meta-analysis

Abstract

ObjectivesWe aimed to conduct a meta-analysis of human papillomavirus (HPV) as a risk factor for oesophageal squamous cell carcinoma (OSCC) in China, using all eligible studies published in the English and Chinese language literature.DesignThe random effect model was used to analyse the pooled OR. The I2 and Q tests were included in the subgroup analyses.SettingLiterature searches of databases including MEDLINE, PUBMED, EMBASE and Chinese National Knowledge Infrastructure (CNKI) and other available resources were performed to retrieve studies investigating OSCC tissue from Chinese participants for the presence of HPV DNA.Primary outcome measureA collective analysis of OSCC cases and control specimens was carried out from 15 case–control studies (6 in the English language and 9 in the Chinese language) for HPV prevalence.ResultsOf a total of 1177 OSCC and 1648 oesophageal control samples, 55% (642/1177) of cancer specimens and 27% (445/1648) of control samples were positive for HPV DNA. A positive strong association between HPV DNA and OSCC was observed among the included studies, with a pooled OR of 3.69 (95% CI 2.74 to 4.96). Heterogeneity and publication bias were not observed in the analysis. Subgroup analyses of the included studies also supported the measure of association of causal links between HPV and OSCC.ConclusionsThis meta-analysis provides the strongest evidence until now of an association between HPV and OSCC in the Chinese population. China has a high burden of OSCC, making this an important research finding. A strength and new contribution of this study is combining data from the English and Chinese language literature to analyse all studies conducted in China. These findings may inform the population level use of prophylactic HPV vaccination to reduce the burden of OSCC in China.

Modifiable factors and esophageal cancer: a systematic review of published meta-analyses

“…A positive association between HPV infection and ESCC was reported in all studies, with overall RRs ranging between 2.69 [55] and 3.32 [56]. However, results varied according to geographical areas (no significant associations found for Europe and America [55,56,61], while a significantly increased risk of ESCC was reported in Asia, with RRs of approximately 4 being reported for China [57,58]) and HPV subtype (HPV-16 was consistently reported as being associated with ESCC, contrarily to HPV-18 and other subtypes [60]).…”

“…Seven studies focused on the association between HPV infection and the occurrence of ESCC [55][56][57][58][59][60][61], while one other did not provide histology-specific estimates [62]. A positive association between HPV infection and ESCC was reported in all studies, with overall RRs ranging between 2.69 [55] and 3.32 [56].…”

Epstein-Barr virus infection and oral squamous cell carcinoma risk: A meta-analysis

“…There is an assumption that viral DNA only acts as a passenger in the OSCC cells or the OSCC cells are susceptible targets and easily get infected, as reported by Horiuchi et al [ 43 ]. However, several other factors may result in a potential bias due to the techniques and assessment of expression, such as the inappropriate study design (neither selecting random nor age-matched sample), differences in techniques and methodologies for detection, interlaboratory variability when using the same test methods, histological classification of tumor tissues, and inaccurate definition of the normal tissues [ 44 ]. Further, results of the subgroup analyses and meta-regression reveal that the year of publication, study location, economic level, sample size, tissue type, detection method and marker, control type, and language might be the sources of heterogeneity, but heterogeneity was only partly explained.…”

Cancer Prevention Research in China

“…With optimization from the demonstration projects, optimized anti-HPV programs can be expanded to the whole nation. A recent meta-analysis showed an association between HPV infection and ESCC in the Chinese population (99). This topic, however, has been controversial and remains to be further investigated.…”