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Title: Determinants of Epstein-Barr virus-positive gastric cancer: an international pooled analysis.
Authors: Camargo MC,  Murphy G,  Koriyama C,  Pfeiffer RM,  Kim WH,  Herrera-Goepfert R,  Corvalan AH,  Carrascal E,  Abdirad A,  Anwar M,  Hao Z,  Kattoor J,  Yoshiwara-Wakabayashi E,  Eizuru Y,  Rabkin CS,  Akiba S
Journal: Br J Cancer
Date: 2011 Jun 28
Branches: BB, IIB, NEB
PubMed ID: 21654677
PMC ID: PMC3137422
Abstract: BACKGROUND: Meta-analyses of the published literature indicate that about 9% of gastric cancers contain Epstein-Barr virus (EBV), with consistent and significant differences by sex and anatomic subsite. This study aimed to identify additional determinants of EBV positivity and their joint effects. METHODS: From 15 international populations with consistent laboratory testing for EBV, we pooled individual-level data for 5081 gastric cancer cases including information on age, sex, subsite, histologic type, diagnostic stage, geographic region, and period of diagnosis. First, we combined population-specific EBV prevalence estimates using random effects meta-analysis. We then aggregated individual-level data to estimate odds ratios of EBV positivity in relation to all variables, accounting for within-population clustering. RESULTS: In unadjusted analyses, EBV positivity was significantly higher in males, young subjects, non-antral subsites, diffuse-type histology, and in studies from the Americas. Multivariable analyses confirmed significant associations with histology and region. Sex interacted with age (P=0.003) and subsite (P=0.002) such that male predominance decreased with age for both subsites. The positivity of EBV was not significantly associated with either stage or time period. CONCLUSION: Aggregating individual-level data provides additional information over meta-analyses. Distinguishing histologic and geographic features as well as interactions among age, sex, and subsite further support classification of EBV-associated gastric cancer as a distinct aetiologic entity.