Highlights
- •Cervical carcinoma was found four times more often in EBV positive patients.
- •The pooled prevalence of EBV is positively associated with cervical lesion grade.
- •EBV/HPV co-infection increases the risk of cervical cancer.
Abstract
Objectives
Human papillomavirus (HPV) has been implicated as a major factor in cervical carcinogenesis.
However, many pieces of evidence gathered over the last two decades suggest Epstein-Barr
virus (EBV) plays a secondary role in this process. The purpose of the present meta-analysis
was to determine whether the presence of EBV infection increases the risk of cervical
carcinoma.
Methods
Based on 25 articles, the analysis yielded a 33.44% overall pooled prevalence of EBV.
Results
The pooled prevalence was higher in patients with carcinoma (43.63%) than in healthy
patients (19.0%) or patients with cervical intraepithelial neoplasia 1 (CIN1) (27.34%)
or CIN2/3 (34.67%). Co-infection with EBV and HPV displayed a similar pattern. EBV
infection was significantly and positively associated with lesion grade in cervical
epithelia and was more prevalent in malignant lesions. Moreover, cervical carcinoma
occurred four times as often among EBV positive women as in women without EBV infection
(OR = 4.01 [1.87–8.58]; p < 0.001).
Conclusions
The existence of EBV(+)HPV(−) carcinomas, the confirmed expression of latent oncoproteins
(EBNA1, EBNA2, LMP1) and EBERs in tumor cells, and the association of EBV with the
integration of high-risk-HPV DNA in malignant specimens point to EBV as a co-factor
(so far underestimated) in the genesis and/or progression of cervical carcinoma. However,
further studies are necessary before the link between EBV and cervical carcinoma can
be established.
Keywords
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Article info
Publication history
Published online: October 09, 2017
Accepted:
October 3,
2017
Received in revised form:
September 30,
2017
Received:
April 19,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
