Epstein-Barr virus infection and oral squamous cell carcinoma risk: A meta-analysis
October
Epstein-Barr virus infection and oral squamous cell carcinoma risk: A meta- analysis
Yangyang She 0 1
Xiaolin Nong 0 1
Min Zhang 0
Menglin Wang 0
0 Editor: Edward Gershburg, Southern Illinois University School of Medicine , UNITED STATES
1 Department of Oral and Maxillofacial Surgery, College and Hospital of Stomatology, Guangxi Medical University , Nanning, Guangxi , China , 2 Department of Prosthodontics, College and Hospital of Stomatology, Peking University , Beijing , China , 3 Department of Otorhinolaryngology and Head and Neck Surgery, The First Affiliated Hospital of Guangxi Medical University , Nanning, Guangxi , China
Conclusions
The results of the current meta-analysis suggest that EBV infection is statistically associated with increased risk of OSCC. However, additional high-quality studies with larger sample sizes are needed to further confirm the relationship between EBV and OSCC.
The evidence for association between Epstein-Barr virus (EBV) infection and risk of oral
squamous cell carcinoma (OSCC) is inconsistent in the literature. Therefore, this
meta-analysis was conducted to clarify this association.
A literature search was conducted in electronic databases for English- and
Chinese-language publications until March 31, 2017 to include eligible case-control studies. The pooled
odds ratio (OR) and 95% confidence interval (95% CI) were estimated to determine the
association between EBV infection and OSCC risk using a fixed- or random-effects model
based on heterogeneity. Publication bias was assessed using funnel plot analysis.
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OPEN ACCESS
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: This study was funded by National
Natural Science Foundation of China (81360404,
http://www.nsfc.gov.cn/); Guangxi Natural Science
Foundation (0832013, http://gxnsf.gxsti.net/stms/
login.jsp); Innovation Project of Guangxi Graduate
Education (201010598RY10), funding receiver
XLN. The funders had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.
Background
Methods
Results
Introduction
Oral squamous cell carcinoma (OSCC) is the most common subset (90%) of oral cancer with a
global incidence of 275,000 cases annually [
1
], the sixth leading malignancy worldwide [
2
]. It
results from the outgrowth of the mucosal epithelium. Local recurrence and regional and
distant metastases can occur even decades after surgery, radiation, and chemotherapy, making
OSCC life-threatening [3]. The 5-year survival rate of late-stage OSCC is only 20% [1]. The
high disease burden and low survival rate highlight the need to better understand the etiology
of OSCC. Established risk factors for OSCC involve long-term betel quid chewing, tobacco
smoking, and alcohol drinking [4±6]. In addition, numerous other possible risk factors have
also been proposed. Recently, it has been demonstrated that individuals with Epstein-Barr
virus (EBV) infection might be at increased risk for OSCC.
EBV is an oncogenic human herpes virus that contains double-stranded DNA, known as
the first human tumor virus [
7,8
]. It appears even in asymptomatic individuals, persisting for
lifelong latent infection [7]. EBV has been well proposed as a causative agent for several types
of epithelial cell malignancies, such as nasopharyngeal carcinoma (NPC) [
9
]. Furthermore,
evidence has shown that EBV is involved in B-lymphocytic cell malignancies, such as Burkitt's
lymphoma and Hodgkin lymphoma [
7,10
].
The strength and consistency of EBV DNA present in OSCC indicate a potentially impor
tant role of EBV infection on OSCC pathogenesis. However, controversial results have been
reported [11±13]. Therefore, a meta-analysis was conducted to assess the association between
EBV infection and OSCC risk.
Methods and materials
Search strategy
The current meta-analysis was conducted based on the Meta-Analysis of Observational Studies
in Epidemiology guidelines [
14
]. Pubmed, Web of Science, Cochrane, and Embase databases
for English-language publications and China National Knowledge Infrastructure (CNKI),
Wanfang Data, Chinese Scientific Journals Fulltext Database (CQVIP), and China Biology
Medicine disc (CBM disc) for Chinese-language publications were searched until March 31,
2017. Keywords used for the Pubmed search are as follows: Search ((((ªEpstein-Barr
Virusº[Title/Abstract]) or ªEBVº[Title/Abstract]) or ªhuman herpesvirus 4º[Title/Abstract]) or ªHHV
4º[Title/Abstract]) and ((((((((ªoral squamous cell carcinomaº[Title/Abstract]) or ªOSCCº[Ti
tle/Abstract]) or ªoral carcinomaº[Title/Abstract]) or ªoral cancerº[Title/Abstract]) or ªtongue
cancerº[Title/Abstract]) or ªbuccal cancerº[Title/Abstract]) or ªoral lesionsº[Title/Abstract])
or (ªhead and neck cancerº[Title/Abstract])). Similar search was conducted in the Web of
Science, Cochrane, (...truncated)