Prognosis of EBV-positive gastric cancer with lymphoid stroma: systematic review and meta-analysis

Abstract

Background

Although gastric cancer with lymphoid stroma (GCLS) presents better prognosis, uncertainty still exists regarding the association of Epstein-Barr virus (EBV) infection with prognosis of GCLS. Therefore, it is urgent to evaluate the outcome and characteristics of EBV-positive GCLS via a systematic review and meta-analysis.

Methods

Three medical databases, with a period ranging from 2000 to so far, were searched for observational studies on EBV infection, clinical characteristics and prognosis. Odds ratio (OR) was used to evaluate the mortality and clinical characteristics of EBV-positive GCLS patients. Egger’s test and subgroup analysis were conducted to identify the source of heterogeneity.

Results

Nine retrospective studies were finally identified, which involved 618 EBV-positive and 153 EBV-negative GCLS patients. The forest plot indicated that EBV-positive GCLS patients had lower mortality (p = .009; 95% CI: 0.15–0.77; I² = 48.6%). Both of funnel plot and Egger’s tests suggested that there was no publication bias. Nonetheless, subgroup analysis indicated that T1–2 stage ratio more than 50% (p < .001; I² = 6.7%) and male ratio more than 80% (p < .001; I² = 0.0%) were valuable for eliminating the heterogeneity. Seven studies including valid information showed that TNM stage of EBV-positive and negative GCLS patients was not statistically different (p = .644; 95% CI: 0.50–1.53; I² = 0.0%).

Conclusions

EBV-positive GCLS tends to have lower mortality, suggesting that detection of EBV infection is necessary to predict prognosis of GCLS.

Keywords:

• Gastric cancer with lymphoid stroma
• Epstein-Barr virus
• prognosis
• systematic review
• meta-analysis

Acknowledgements

This work was granted by the National Natural Science Foundation of China (81903011, 81903008, 82072801, 82173316), Fundamental Research Funds for the Central Universities (2019kfyRCPY032, 2012QN224, 2013ZHYX003, 01-18-530112, 01-18-530115) and Natural Science Foundation of Hubei Province (2014CFA012).

Author contributions

Tianxin Ying: manuscript preparation and data analysis; Jie Chen, Banghe Bao, Yi Zhou and Jiyu Song: manuscript editing; Liduan Zheng: final approval.

Ethical approval

This meta-analysis does not involve human subjects. IRB review is not required.

Disclosure statement

All the authors declare no conflicts of interest.

Data availability statement

All data in this manuscript can be found in the literature as cited in the text.

Additional information

Funding

This work was granted by the National Natural Science Foundation of China (81903011, 81903008, 82072801, 82173316), Fundamental Research Funds for the Central Universities (2019kfyRCPY032, 2012QN224, 2013ZHYX003, 01-18-530112, 01-18-530115) and Natural Science Foundation of Hubei Province (2014CFA012).