Abstract
BackgroundLung cancer has emerged as a global public health problem and is the most common cause of cancer deaths by absolute cases globally. Besides tobacco, smoke infectious diseases such as human papillomavirus (HPV) might be involved in the pathogenesis of lung cancer. However, data are inconsistent due to differences in study design and HPV detection methods.AimA systematic meta‐analysis was performed to examine the presence of HPV‐infection with lung cancer.Methods and ResultsAll studies in all languages were considered for the search concepts “lung cancer” and “HPV” if data specific to HPV prevalence in lung cancer tissue were given. This included Journal articles as well as abstracts and conference reports. As detection method, only HPV PCR results from fresh frozen and paraffin‐embedded tissue were included. Five bibliographic databases and three registers of clinical trials including MEDLINE, Embase, Cochrane Library, and ClinicalTrials.gov were searched through February 2020. A total 4298 publications were identified, and 78 publications were selected, resulting in 9385 included lung cancer patients. A meta‐analysis of 15 case‐control studies with n = 2504 patients showed a weighted overall prevalence difference of 22% (95% CI: 12%‐33%; P < .001) and a weighted overall 4.7‐fold (95% CI: 2.7‐8.4; P < .001) increase of HPV prevalence in lung cancer patients compared to controls. Overall, HPV prevalence amounted to 13.5% being highest in Asia (16.6%), followed by America (12.8%), and Europe (7.0%). A higher HPV prevalence was found in squamous cell carcinoma (17.9%) compared to adenocarcinoma (P < .01) with significant differences in geographic patterns. HPV genotypes 16 and 18 were the most prevalent high‐risk genotypes identified.ConclusionIn conclusion, our review provides convincing evidence that HPV infection increases the risk of developing lung cancer.
Highlights
Lung cancer is estimated to be the leading cause of cancer-related mortality worldwide, with 2.1 million new lung cancer cases and 1.8 million predicted deaths worldwide in 2018.1 smoking by far has been identified as the most important risk factor in lung cancer, other interactions with environmental and/or genetic risk factors as well as infectious diseases have been identified to contribute to the pathogenesis of lung cancer as well.Viral infections, such as human papillomavirus (HPV) infections have been reported to be an important risk factor of cervical cancer if genotypes with a high oncogenic risk are found
The current study focused on the prevalence of HPV infections in lung cancer patients in which HPV detection was performed by means of polymerase chain reaction (PCR) from fresh frozen and/or paraffin-embedded tissue to first minimize differences in HPV prevalence due to methodological bias and second to rely on the method with the highest sensitivity to detect HPV positivity, which has been proven to have the highest sensitivity in earlier studies.[4,5]
Comparing HPV prevalence of patients with lung cancer and controls in a meta-analysis, using the 15 casecontrol studies with a total of 2504 patients, a higher prevalence could be found for the lung cancer patients for prevalence difference (PD = 0.22; 95%-CI, 0.12-0.33; P < .001) as well as prevalence ratio (PR = 4.7; 95% CI, 2.7-8.4; P < .001)
Summary
Lung cancer is estimated to be the leading cause of cancer-related mortality worldwide, with 2.1 million new lung cancer cases and 1.8 million predicted deaths worldwide in 2018.1 smoking by far has been identified as the most important risk factor in lung cancer, other interactions with environmental and/or genetic risk factors as well as infectious diseases have been identified to contribute to the pathogenesis of lung cancer as well Viral infections, such as human papillomavirus (HPV) infections have been reported to be an important risk factor of cervical cancer if genotypes with a high oncogenic risk are found. Methods and Results: All studies in all languages were considered for the search concepts “lung cancer” and “HPV” if data specific to HPV prevalence in lung cancer tissue were given This included Journal articles as well as abstracts and conference reports. Conclusion: In conclusion, our review provides convincing evidence that HPV infection increases the risk of developing lung cancer
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