Evidence Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2021; 10(5): 209-216
Published online Sep 25, 2021. doi: 10.5501/wjv.v10.i5.209
Human papillomavirus infection and gastric cancer risk: A meta-epidemiological review
Jong-Myon Bae
Jong-Myon Bae, Department of Preventive Medicine, Jeju National University College of Medicine, Jeju-si 63243, Jeju Province, South Korea
Author contributions: Bae JM performed the literature review, conducted the statistical analysis, and wrote the paper.
Conflict-of-interest statement: The author declares no conflict of interests and no funding sources for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jong-Myon Bae, MD, PhD, Professor, Department of Preventive Medicine, Jeju National University College of Medicine, 102 Jejudaehak-ro, Jeju-si 63243, Jeju Province, South Korea. jmbae@jejunu.ac.kr
Received: February 16, 2021
Peer-review started: February 16, 2021
First decision: March 17, 2021
Revised: March 26, 2021
Accepted: July 22, 2021
Article in press: July 22, 2021
Published online: September 25, 2021
Abstract

Gastric cancer (GC) is a multifactorial disease, and several modifiable risk factors have been reported. This review summarizes and interprets two previous quantitative systematic reviews evaluating the association between human papillomavirus (HPV) infection and GC risk. The results of two systematic reviews evaluating the same hypothesis showed a statistically significant difference in summary odds ratios and their 95% confidence intervals. Thus, it is necessary to conduct a subgroup analysis of Chinese and non-Chinese studies. Additional meta-analyses that control for heterogeneity are required. Reanalysis showed that all the Chinese studies had statistical significance, whereas the non-national studies did not. The funnel plot asymmetry and Egger's test confirmed publication bias in the Chinese studies. In addition, the proportion of HPV-positive cases in Chinese studies was 1.43 times higher than that in non-Chinese studies and 2.81 times lower in controls. Therefore, the deduced evidence is currently insufficient to conclude that HPV infection is associated with GC risk.

Keywords: Papillomavirus, Stomach neoplasm, Case-control studies, Meta-analysis, Systematic review, Risk factors

Core Tip: Chinese studies showed that human papillomavirus infections increased the risk of gastric cancer; however, non-Chinese studies showed no statistical significance. Therefore, the deduced evidence is currently inadequate to conclude that human papillomavirus infection is associated with gastric cancer risk.