Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India.
Medical Laboratories Techniques Department, AL-Mustaqbal University, Hillah, Babil, Iraq.
Medicine (Baltimore). 2024 Aug 2;103(31):e38827. doi: 10.1097/MD.0000000000038827.
Cervical cancer, predominantly caused by the human papillomavirus (HPV), is a major health challenge in India, with high morbidity and mortality rates. Given India's vast geographic and socio-economic diversity, understanding regional variations in HPV prevalence is crucial for developing targeted and effective public health interventions. This systematic review and meta-analysis were conducted to elucidate the prevalence of HPV among cervical cancer patients in India.
A literature search was executed across PubMed, EMBASE, and Web of Science up to December 07, 2023. Observational studies reporting HPV prevalence among cervical cancer patients in India are included. A Modified Newcastle-Ottawa scale was used for quality assessment. A random-effects meta-analysis was used to determine pooled HPV prevalence, and heterogeneity was evaluated using the I² statistic. Subgroup and sensitivity analyses were performed to assess result stability and investigate heterogeneity sources. All statistical analyses were performed using R software version 4.3.
The meta-analysis included 17 studies with a total of 2529 cervical cancer cases, of which 1977 were HPV-positive. The pooled HPV prevalence was 85% (95% CI: 71-92%), with substantial heterogeneity (I² = 94%). Subgroup analysis by geographic zones showed notable differences: South (88%, 95% CI: 76-95%), North (73%, 95% CI: 1-100%), East (99%, 95% CI: 1-100%), Central (71%, 95% CI: 54-84%), and West (77%, 95% CI: 0-100%). Sensitivity analysis demonstrated the consistency of the results, and a reanalysis, excluding influential studies, yielded a prevalence of 82% (95% CI: 67-91%).
Our analysis reveals a high prevalence of HPV in cervical cancer patients in India, with significant regional variations. The observed heterogeneity highlights the complexity of HPV epidemiology in India and necessitates further research to explore underlying causes and regional characteristics. Future studies should aim to expand geographic representation and deepen understanding of the factors contributing to the variability in HPV prevalence.
宫颈癌主要由人乳头瘤病毒（HPV）引起，是印度面临的重大健康挑战，其发病率和死亡率都很高。鉴于印度地域和社会经济差异巨大，了解 HPV 流行率的地区差异对于制定有针对性和有效的公共卫生干预措施至关重要。本系统评价和荟萃分析旨在阐明 HPV 在印度宫颈癌患者中的流行率。
我们在 PubMed、EMBASE 和 Web of Science 上进行了文献检索，检索截至 2023 年 12 月 07 日。纳入报告 HPV 在印度宫颈癌患者中流行率的观察性研究。使用改良的纽卡斯尔-渥太华量表进行质量评估。使用随机效应荟萃分析确定 HPV 总体流行率，并使用 I²统计量评估异质性。进行亚组和敏感性分析，以评估结果的稳定性并探究异质性来源。所有统计分析均使用 R 软件版本 4.3 进行。
荟萃分析纳入了 17 项研究，共计 2529 例宫颈癌病例，其中 1977 例 HPV 阳性。HPV 总体流行率为 85%（95%CI：71%-92%），存在显著异质性（I²=94%）。按地理区域进行亚组分析显示存在显著差异：南部（88%，95%CI：76%-95%）、北部（73%，95%CI：1%-100%）、东部（99%，95%CI：1%-100%）、中部（71%，95%CI：54%-84%）和西部（77%，95%CI：0%-100%）。敏感性分析证实了结果的一致性，重新分析排除了有影响力的研究后，流行率为 82%（95%CI：67%-91%）。
我们的分析表明，印度宫颈癌患者中 HPV 流行率较高，且存在显著的地区差异。观察到的异质性突出了 HPV 流行病学在印度的复杂性，需要进一步研究以探究其潜在原因和区域特征。未来的研究应旨在扩大地域代表性，深入了解导致 HPV 流行率变化的因素。
