Gagandeep Kaur, Tami Yap, Rishi Ramani, Michael McCullough, Ankur Singh
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引用次数: 0
摘要
目的：高危人乳头瘤病毒（HPV）是口咽癌的公认病因。它们与口腔癌的关系仍不明确，检测率从 0% 到 100% 不等。仅靠 HPV DNA 检测或暴露证据不足以得出因果关系的结论。本系统综述评估了口腔癌HPV检测研究的偏倚程度：方法：在 PubMed、Ovid MEDLINE、EMBASE 和 PsycInfo 数据库中检索了报告 HPV 对口腔特定癌症影响的观察性研究：纳入的 15 项研究都进行了 HPV DNA 检测或血清 HPV 抗体检测，但没有一项研究进行了 mRNA E6/E7 分析。与对照组相比，口腔癌病例检测到 HPV 的几率高出 5.36 倍（95% CI 3.29-8.72）。与血液样本（OR 3.36；95% CI 1.53-7.40）相比，细胞样本（OR 6.93；95% CI 0.82-58.55）和组织样本（OR 5.28；95% CI 3.41-8.18）检测到 HPV 的几率更高：当明确区分口咽部和口腔的癌症部位时，有12项研究显示HPV与口腔癌密切相关，但由于测量结果不一致、混杂因素较多以及缺乏金标准测试，现有的估计值缺乏内部有效性。目前还没有高质量的证据可以断定人乳头瘤病毒与口腔癌之间存在因果关系。
Assessing bias in the causal role of HPV in oral cancer: A systematic review and meta-analysis.
Objective: High-risk human papillomaviruses (HPV) are an established cause of oropharyngeal cancer. Their relationship with oral cancer remains unclear with detection ranging from 0% to 100%. HPV DNA detection or evidence of exposure alone is insufficient to conclude causality. This systematic review assesses the extent of bias in studies of HPV detection in cancers of the oral cavity.
Methods: PubMed, Ovid MEDLINE, EMBASE, and PsycInfo databases were searched for observational studies reporting the effect of HPV in oral cavity specific cancers.
Results: All 15 included studies presented HPV DNA detection or serum HPV-antibodies, none included mRNA E6/E7 analysis. Cases with oral cancer had 5.36 times (95% CI 3.29-8.72) higher odds of having HPV detected compared to controls. The odds of HPV detection were higher in cell-based (OR 6.93; 95% CI 0.82-58.55) and tissue samples (OR 5.28; 95% CI 3.41-8.18) than blood-based samples (OR 3.36; 95% CI 1.53-7.40).
Conclusion: When cancer site is clearly differentiated between oropharynx and oral cavity, 12 studies showed strong association between HPV and oral cancer, but the available estimates lack internal validity due to inconsistent measurements, high confounding, and lack of gold standard testing. There is not high-quality evidence to conclude a causal relationship of HPV with oral cancer.
期刊介绍：
Oral Diseases is a multidisciplinary and international journal with a focus on head and neck disorders, edited by leaders in the field, Professor Giovanni Lodi (Editor-in-Chief, Milan, Italy), Professor Stefano Petti (Deputy Editor, Rome, Italy) and Associate Professor Gulshan Sunavala-Dossabhoy (Deputy Editor, Shreveport, LA, USA). The journal is pre-eminent in oral medicine. Oral Diseases specifically strives to link often-isolated areas of dentistry and medicine through broad-based scholarship that includes well-designed and controlled clinical research, analytical epidemiology, and the translation of basic science in pre-clinical studies. The journal typically publishes articles relevant to many related medical specialties including especially dermatology, gastroenterology, hematology, immunology, infectious diseases, neuropsychiatry, oncology and otolaryngology. The essential requirement is that all submitted research is hypothesis-driven, with significant positive and negative results both welcomed. Equal publication emphasis is placed on etiology, pathogenesis, diagnosis, prevention and treatment.
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