Prevalence and Association of Human Papillomavirus with Esophageal Squamous Cell Carcinoma in Iran: A Systematic Review and Meta-Analysis

BACKGROUND: Human papillomavirus (HPV) can infect the epithelium of the esophagus, but so far there is no reliable and comprehensive evidence about the prevalence and association of HPV with esophageal cancer in Iran, as high incidence region. This study aimed to evaluate the prevalence and association of HPV with esophageal squamous cell carcinoma (ESCC) in Iran. METHODS: Relevant English and Persian articles published up to Aug 2017 and indexed in databases were reviewed. Frequency of HPV genotypes in ESCC cases and controls was surveyed according to regions of Iran. Data were meta-analyzed with random effects models using Comprehensive Meta-Analysis software. RESULTS: Overall, 14 studies were eligible including 1444 samples (1062 ESCC cases and 382 controls). HPV was positive in 269 (25.32%) of 1062 ESCC cases and in 65 (17.01%) of 382 controls. Total prevalence of HPV in both groups was estimated 0.256 (95%CI, 0.208%–0.310%). The prevalence of HPV-16 and HPV-18 was estimated 0.121 (95%CI: 0.087–0.183) and 0.046 (95%CI; 0.023–0.088), respectively. The difference in HPV prevalence in different regions of Iran was statistically significant (Q=18.20, df =4, P=0.001). In 6 case-control studies, the pooled odds ratio was estimated 1.99 (95%CI; 0.916–4.315). CONCLUSION: High-risk HPVs were observed in ESCC cases and controls from different regions of Iran. The odds ratio indicates that the HPV infection in ESCC cases was approximately 2 fold more than the controls. More case-control studies in other populations with larger sample size are necessary.