Clinicopathological and molecular characteristics of Epstein-Barr virus-associated gastric carcinoma: a meta-analysis

J Gastroenterol Hepatol. 2009 Mar;24(3):354-65. doi: 10.1111/j.1440-1746.2009.05775.x.


There is conflicting data regarding the clinicopathological significance of the risk factors associated with Epstein-Barr virus (EBV)-associated gastric carcinoma (EBVaGC). To address this controversy, we performed a meta-analysis for the clinicopathological and molecular characteristics of EBVaGC. The relevant published studies were reviewed according to the defined selection criteria. The effect sizes of the outcome parameters were estimated by an odds ratio or a weighted mean difference. This meta-analysis included 48 studies that encompassed a total of 9738 patients. The frequency of EBVaGC was 8.8%, and EBVaGC was significantly associated with ethnicity. It was more predominant in men and in younger individuals. Interestingly, EBVaGC was more prevalent in Caucasian and Hispanic patients than in Asian ones. EBVaGC developed most often in the cardia and body, and it generally showed the diffuse histological type. EBV was highly prevalent in the patients with lymphoepithelial carcinoma. EBVaGC was closely associated with remnant cancer and a CpG island methylator-high status, but not with Helicobacter pylori infection, a TP53 expression, and p53 mutation. In addition, EBVaGC was not significantly associated with the depth of invasion, lymph node metastasis, or the clinical stage. The clinicopathological and molecular characteristics of EBVaGC are quite different from those of conventional gastric adenocarcinoma. However, further study is needed to determine the effect of EBV on the survival of EBVaGC patients.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Age Factors
  • Aged
  • Carcinoma / ethnology
  • Carcinoma / genetics
  • Carcinoma / microbiology
  • Carcinoma / pathology
  • Carcinoma / virology*
  • CpG Islands
  • DNA Methylation
  • Epstein-Barr Virus Infections / complications*
  • Epstein-Barr Virus Infections / ethnology
  • Female
  • Gene Expression Regulation, Neoplastic
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / isolation & purification
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Odds Ratio
  • Prognosis
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Stomach Neoplasms / ethnology
  • Stomach Neoplasms / genetics
  • Stomach Neoplasms / microbiology
  • Stomach Neoplasms / pathology
  • Stomach Neoplasms / virology*
  • Tumor Suppressor Protein p53 / genetics


  • TP53 protein, human
  • Tumor Suppressor Protein p53