Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 6120 Executive Boulevard., Rockville, MD 20852, USA.
Br J Cancer. 2011 Jun 28;105(1):38-43. doi: 10.1038/bjc.2011.215. Epub 2011 Jun 7.
Meta-analyses of the published literature indicate that about 9% of gastric cancers contain Epstein-Barr virus (EBV), with consistent and significant differences by sex and anatomic subsite. This study aimed to identify additional determinants of EBV positivity and their joint effects.
From 15 international populations with consistent laboratory testing for EBV, we pooled individual-level data for 5081 gastric cancer cases including information on age, sex, subsite, histologic type, diagnostic stage, geographic region, and period of diagnosis. First, we combined population-specific EBV prevalence estimates using random effects meta-analysis. We then aggregated individual-level data to estimate odds ratios of EBV positivity in relation to all variables, accounting for within-population clustering.
In unadjusted analyses, EBV positivity was significantly higher in males, young subjects, non-antral subsites, diffuse-type histology, and in studies from the Americas. Multivariable analyses confirmed significant associations with histology and region. Sex interacted with age (P=0.003) and subsite (P=0.002) such that male predominance decreased with age for both subsites. The positivity of EBV was not significantly associated with either stage or time period.
Aggregating individual-level data provides additional information over meta-analyses. Distinguishing histologic and geographic features as well as interactions among age, sex, and subsite further support classification of EBV-associated gastric cancer as a distinct aetiologic entity.
已发表文献的荟萃分析表明，约 9%的胃癌含有 Epstein-Barr 病毒（EBV），且其阳性率在性别和解剖部位上存在显著差异。本研究旨在确定 EBV 阳性的其他决定因素及其共同作用。
我们从 15 个具有 EBV 检测一致性的国际人群中收集了 5081 例胃癌病例的个体水平数据，这些数据包括年龄、性别、解剖部位、组织学类型、诊断分期、地理区域和诊断时期等信息。首先，我们使用随机效应荟萃分析对特定人群的 EBV 流行率进行了综合评估。然后，我们汇总了个体水平的数据，以估计 EBV 阳性与所有变量的比值比，同时考虑了人群内的聚类效应。
在未调整的分析中，EBV 阳性在男性、年轻患者、非贲门部位、弥漫型组织学和美洲地区的研究中显著更高。多变量分析证实了与组织学和地域的显著相关性。性别与年龄（P=0.003）和部位（P=0.002）存在交互作用，即在两个部位，男性的优势都随年龄的增加而降低。EBV 的阳性与分期或时期均无显著相关性。
汇总个体水平的数据提供了比荟萃分析更全面的信息。区分组织学和地域特征，以及年龄、性别和部位之间的相互作用，进一步支持将 EBV 相关胃癌归类为一个独特的病因实体。
