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Abstract：
BACKGROUND: Despite numerous studies having evaluated the associations between human papillomavirus (HPV) infection and risk of specific cancers other than anogenital tract and oropharyngeal, the findings are inconsistent and the quality of evidence has not been systematically quantified. We aimed to summarise the existing evidence as well as to evaluate the strength and credibility of these associations.
METHODS: We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, EMBASE, and Web of Science were searched from inception to March 2024. Studies with systematic reviews and meta-analyses that examined associations between HPV or HPV-associated genotypes infection and specific cancers were eligible for this review. The quality of the methodology was evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR). The credibility of the evidence was assessed using GRADE. The protocol was preregistered with PROSPERO (CRD42023439070).
RESULTS: The umbrella review identified 31 eligible studies reporting 87 associations with meta-analytic estimates, including 1191 individual studies with 336,195 participants. Of those, 29 (93.5%) studies were rated as over moderate quality by AMSTAR. Only one association indicating HPV-18 infection associated with an increased risk of breast cancer (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 2.24-5.41) was graded as convincing evidence. There were five unique outcomes identified as highly suggestive evidence, including HPV infection increased the risk of oral squamous cell carcinoma (OR = 7.03, 95% CI = 3.87-12.76), oesophageal cancer (OR = 3.32, 95% CI = 2.54-4.34), oesophageal squamous cell carcinoma (OR = 2.69, 95% CI = 2.05-3.54), lung cancer (OR = 3.60, 95% CI = 2.59-5.01), and breast cancer (OR = 6.26, 95% CI = 4.35-9.00). According to GRADE, one association was classified as high, indicating that compared with the controls in normal tissues, HPV infection was associated with an increased risk of breast cancer.
CONCLUSIONS: The umbrella review synthesised up-to-date observational evidence on HPV infection with the risk of breast cancer, oral squamous cell carcinoma, oesophageal cancer, oesophageal squamous cell carcinoma, and lung cancer. Further larger prospective cohort studies are needed to verify the associations, providing public health recommendations for prevention of disease.
BACKGROUND: National Key Research and Development Program of China, Natural Science Foundation of China, Outstanding Scientific Fund of Shengjing Hospital of China Medical University, and 345 Talent Project of Shengjing Hospital of China Medical University.
METHODS: We conducted an umbrella review of systematic reviews and meta-analyses of observational studies. PubMed, EMBASE, and Web of Science were searched from inception to March 2024. Studies with systematic reviews and meta-analyses that examined associations between HPV or HPV-associated genotypes infection and specific cancers were eligible for this review. The quality of the methodology was evaluated using A Measurement Tool to Assess systematic Reviews (AMSTAR). The credibility of the evidence was assessed using GRADE. The protocol was preregistered with PROSPERO (CRD42023439070).
RESULTS: The umbrella review identified 31 eligible studies reporting 87 associations with meta-analytic estimates, including 1191 individual studies with 336,195 participants. Of those, 29 (93.5%) studies were rated as over moderate quality by AMSTAR. Only one association indicating HPV-18 infection associated with an increased risk of breast cancer (odds ratio [OR] = 3.48, 95% confidence interval [CI] = 2.24-5.41) was graded as convincing evidence. There were five unique outcomes identified as highly suggestive evidence, including HPV infection increased the risk of oral squamous cell carcinoma (OR = 7.03, 95% CI = 3.87-12.76), oesophageal cancer (OR = 3.32, 95% CI = 2.54-4.34), oesophageal squamous cell carcinoma (OR = 2.69, 95% CI = 2.05-3.54), lung cancer (OR = 3.60, 95% CI = 2.59-5.01), and breast cancer (OR = 6.26, 95% CI = 4.35-9.00). According to GRADE, one association was classified as high, indicating that compared with the controls in normal tissues, HPV infection was associated with an increased risk of breast cancer.
CONCLUSIONS: The umbrella review synthesised up-to-date observational evidence on HPV infection with the risk of breast cancer, oral squamous cell carcinoma, oesophageal cancer, oesophageal squamous cell carcinoma, and lung cancer. Further larger prospective cohort studies are needed to verify the associations, providing public health recommendations for prevention of disease.
BACKGROUND: National Key Research and Development Program of China, Natural Science Foundation of China, Outstanding Scientific Fund of Shengjing Hospital of China Medical University, and 345 Talent Project of Shengjing Hospital of China Medical University.
摘要：
背景：尽管有许多研究评估了人乳头瘤病毒（HPV）感染与除肛门生殖道和口咽以外的特定癌症风险之间的关联，研究结果不一致,证据质量尚未得到系统量化.我们旨在总结现有证据，并评估这些协会的实力和可信度。
方法：我们对观察性研究进行了系统综述和荟萃分析。PubMed,EMBASE,和WebofScience从成立到2024年3月进行了搜索。通过系统评价和荟萃分析检查HPV或HPV相关基因型感染与特定癌症之间的关联的研究符合该评价。使用评估系统评论的测量工具(AMSTAR)评估方法的质量。使用GRADE评估证据的可信度。该方案在PROSPERO(CRD42023439070)中预先注册。
结果：总括审查确定了31项符合条件的研究，报告了87项与荟萃分析估计的关联，包括1191项个人研究，336,195名参与者。其中,29项(93.5%)研究被AMSTAR评为中等质量。只有一个表明HPV-18感染与乳腺癌风险增加相关的关联（比值比[OR]=3.48，95％置信区间[CI]=2.24-5.41）被分级为令人信服的证据。有五个独特的结果被确定为高度暗示性的证据，包括HPV感染增加口腔鳞状细胞癌的风险（OR=7.03，95％CI=3.87-12.76），食管癌（OR=3.32，95%CI=2.54-4.34），食管鳞状细胞癌（OR=2.69，95%CI=2.05-3.54），肺癌（OR=3.60，95%CI=2.59-5.01），和乳腺癌（OR=6.26，95％CI=4.35-9.00）。根据等级,一个协会被归类为高，表明与正常组织中的对照相比，HPV感染与乳腺癌风险增加有关。
结论：综述综合了HPV感染与乳腺癌风险相关的最新观察证据，口腔鳞状细胞癌，食道癌,食管鳞状细胞癌，还有肺癌.需要进一步更大的前瞻性队列研究来验证这些关联，为预防疾病提供公共卫生建议。
背景：国家重点研究发展计划，中国自然科学基金,中国医科大学附属盛京医院优秀科学基金,中国医科大学附属盛京医院345人才工程。
方法：我们对观察性研究进行了系统综述和荟萃分析。PubMed,EMBASE,和WebofScience从成立到2024年3月进行了搜索。通过系统评价和荟萃分析检查HPV或HPV相关基因型感染与特定癌症之间的关联的研究符合该评价。使用评估系统评论的测量工具(AMSTAR)评估方法的质量。使用GRADE评估证据的可信度。该方案在PROSPERO(CRD42023439070)中预先注册。
结果：总括审查确定了31项符合条件的研究，报告了87项与荟萃分析估计的关联，包括1191项个人研究，336,195名参与者。其中,29项(93.5%)研究被AMSTAR评为中等质量。只有一个表明HPV-18感染与乳腺癌风险增加相关的关联（比值比[OR]=3.48，95％置信区间[CI]=2.24-5.41）被分级为令人信服的证据。有五个独特的结果被确定为高度暗示性的证据，包括HPV感染增加口腔鳞状细胞癌的风险（OR=7.03，95％CI=3.87-12.76），食管癌（OR=3.32，95%CI=2.54-4.34），食管鳞状细胞癌（OR=2.69，95%CI=2.05-3.54），肺癌（OR=3.60，95%CI=2.59-5.01），和乳腺癌（OR=6.26，95％CI=4.35-9.00）。根据等级,一个协会被归类为高，表明与正常组织中的对照相比，HPV感染与乳腺癌风险增加有关。
结论：综述综合了HPV感染与乳腺癌风险相关的最新观察证据，口腔鳞状细胞癌，食道癌,食管鳞状细胞癌，还有肺癌.需要进一步更大的前瞻性队列研究来验证这些关联，为预防疾病提供公共卫生建议。
背景：国家重点研究发展计划，中国自然科学基金,中国医科大学附属盛京医院优秀科学基金,中国医科大学附属盛京医院345人才工程。
