Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
Clin Gastroenterol Hepatol. 2023 Apr;21(4):922-930.e21. doi: 10.1016/j.cgh.2022.07.042. Epub 2022 Aug 10.
BACKGROUND & AIMS: Evidence suggests that a fraction of new gastric cancer cases may be etiologically associated with Epstein-Barr virus (EBV), a known carcinogenic agent. We aimed to systematically explore the proportion of EBV-positive gastric cancer.
We did a systematic review (PROSPERO CRD42020164473) from January 1990 to August 2021. For each country and geographical region with available data, pooled prevalence and corresponding 95% confidence intervals (CIs) of EBV in gastric tumors were calculated for 3 subtypes of gastric adenocarcinoma (conventional adenocarcinoma, lymphoepithelioma-like gastric carcinoma, and remnant/stump carcinoma). For conventional adenocarcinoma, prevalence ratios (PRs) were presented for sex, Lauren's classification, gastric cancer stage, and anatomical location of the stomach.
In 220 eligible studies including over 68,000 cases of conventional gastric adenocarcinoma, EBV prevalence in tumor cells was 7.5% (95% CI, 6.9%-8.1%) and was higher in men compared with women (PR, 2.1; 95% CI, 1.9-2.4), in diffuse type compared with intestinal type (PR, 1.3; 95% CI, 1.1-1.5), and in the proximal region compared with the distal region (PR, 2.5; 95% CI, 2.0-3.1). There was no difference in EBV prevalence by gastric cancer stage. EBV prevalence was 75.9% (95% CI, 62.8%-85.5%) among lymphoepithelioma-like gastric carcinoma and 26.3% (95% CI, 22.2%-32.0%) among remnant or stump carcinoma.
Assuming a causal association between EBV and gastric cancer, our findings, when applied to the GLOBOCAN 2020 gastric cancer incidence, suggest that primary prevention such as the development of an effective EBV vaccine might prevent 81,000 EBV-associated gastric cancer cases worldwide annually.
有证据表明，一部分新发胃癌病例可能与已知致癌因子 Epstein-Barr 病毒（EBV）有关。本研究旨在系统性地探究 EBV 阳性胃癌的比例。
我们进行了一项系统性综述（PROSPERO CRD42020164473），检索时间为 1990 年 1 月至 2021 年 8 月。对于每个有可用数据的国家和地区，计算了胃腺癌 3 种亚型（普通型腺癌、淋巴上皮样胃癌和残胃癌/胃切端癌）中 EBV 的总流行率及相应的 95%置信区间（CI）。对于普通型腺癌，还展示了 EBV 流行率与性别、Lauren 分类、胃癌分期和胃解剖部位的比值比（PR）。
在 220 项纳入的研究中，共包括超过 68000 例普通型胃腺癌病例，肿瘤细胞中 EBV 的流行率为 7.5%（95%CI，6.9%-8.1%），男性高于女性（PR，2.1；95%CI，1.9-2.4），弥漫型高于肠型（PR，1.3；95%CI，1.1-1.5），近端高于远端（PR，2.5；95%CI，2.0-3.1）。但胃癌分期与 EBV 流行率无关。淋巴上皮样胃癌中 EBV 的流行率为 75.9%（95%CI，62.8%-85.5%），残胃癌/胃切端癌中为 26.3%（95%CI，22.2%-32.0%）。
假设 EBV 与胃癌之间存在因果关系，根据本研究结果（应用于 2020 年 GLOBOCAN 胃癌发病率数据），全球每年可能会有 81000 例由 EBV 引起的胃癌病例可以通过一级预防（如开发有效的 EBV 疫苗）来预防。
