Zhang Guofei, Yu Zipu, Shen Gang, Chai Ying, Liang Chengxiao
1Department of Thoracic Surgery, the Second Affiliated Hospital, College of Medicine, Zhejiang University, # 88 Jiefang Road, Hangzhou, 310009 China.
2Department of Surgery, Zhejiang Hospital, # 12 Lingyin Road, Hangzhou, 310013 China.
Infect Agent Cancer. 2019 Nov 6;14:32. doi: 10.1186/s13027-019-0254-5. eCollection 2019.
The possible role of Epstein-Barr virus (EBV) in the pathogenesis of thymic epithelial tumors (TET) remains controversial. This study aimed to determine the prevalence of EBV in TET. We conducted a systematic review of relevant English-language studies published between January 1980 and December 2013. Effect size was calculated as event rates (95% confidence interval [CI]) by homogeneity testing using Cochran's Q and I statistics for benign TET, benign TET with myasthenia gravis (MG), and thymic carcinoma (TC). Among 136 potentially relevant studies, 22 met the inclusion criteria. Despite a considerable degree of heterogeneity, the pooled estimated incidences were 9% (95% CI, 1-23%), 20% (95% CI, 0-54%), and 6% (95% CI, 0-21%) for benign TET, benign TET with MG, and TC, respectively. There was significant heterogeneity among studies that used in situ hybridization (ISH) for both benign TET and benign TET with MG. According to the random-effects model, studies employing ISH yielded lower point estimates of EBV prevalence (5%) than those employing other methods (33%). Using the random-effects model, we found a lack of significant heterogeneity among studies from different geographic regions ( = 0.0848). Further, 12 of 23 lymphoepithelioma-like carcinoma (LELC) cases tested EBV-positive. The prevalence of EBV in benign TET with or without MG was lower than in nasopharyngeal carcinoma, suggesting that EBV plays a minor role in TET pathogenesis. Although the prevalence of EBV in TC was also low, EBV may play an important causal role in LELC. Further research is needed to clarify these associations.
爱泼斯坦-巴尔病毒（EBV）在胸腺上皮肿瘤（TET）发病机制中的潜在作用仍存在争议。本研究旨在确定EBV在TET中的流行率。我们对1980年1月至2013年12月发表的相关英文研究进行了系统评价。通过使用 Cochr an's Q和I统计量进行同质性检验，计算良性TET、伴重症肌无力（MG）的良性TET和胸腺癌（TC）的效应大小作为事件发生率（95%置信区间[CI]）。在136项潜在相关研究中，22项符合纳入标准。尽管存在相当程度的异质性，但良性TET、伴MG的良性TET和TC的合并估计发病率分别为9%（95%CI，1 - 23%）、20%（95%CI，0 - 54%）和6%（95%CI，0 - 21%）。对于良性TET和伴MG的良性TET，使用原位杂交（ISH）的研究之间存在显著异质性。根据随机效应模型，采用ISH的研究得出的EBV流行率点估计值（5%）低于采用其他方法的研究（33%）。使用随机效应模型，我们发现来自不同地理区域的研究之间缺乏显著异质性（I² = 0.0848）。此外，23例淋巴上皮瘤样癌（LELC）病例中有12例EBV检测呈阳性。伴或不伴MG的良性TET中EBV的流行率低于鼻咽癌中的流行率，这表明EBV在TET发病机制中起次要作用。虽然TC中EBV的流行率也较低，但EBV可能在LELC中起重要的因果作用。需要进一步研究来阐明这些关联。
