Clinical characteristics and prognostic significance of EBER positivity in diffuse large B-cell lymphoma: A meta-analysis

Recent studies show that Epstein-Barr virus (EBV) positivity might be related to adverse prognosis in patients with diffuse large B-cell lymphoma (DLBCL), but the results are still inconclusive. We conducted this meta-analysis to define the clinical value of EBV infection in DLBCL. All potential articles in PubMed, Web of Science, Medline, and Embase were retrieved. Using the random-effects or fixed-effect model, pooled hazard ratios (HRs) or relative risk (RR) with 95% confidence intervals (CIs) were used to calculate the correlation between EBER and prognosis and clinical features in DLBCL. A total of 13 qualified studies with 4111 patients were identified in our meta-analysis based on the inclusion and exclusion criteria. The overall estimates revealed that EBV-encoded small RNAs (EBER) positivity was significantly correlated with worse overall survival (HR = 2.43, 95% CI: 1.73 +/- 3.36) and progression-free survival (HR = 3.60, 95% CI: 2.07 +/- 6.26). In addition, EBER positivity was associated with age older than 60 years (RR = 1.51, 95% CI: 1.02 +/- 2.24), male sex (RR = 1.34, 95% CI: 1.05 +/- 1.71), more advanced stage (RR = 2.25, 95% CI: 1.72 +/- 2.96), high international prognostic index (RR = 2.20, 95% CI: 1.71 +/- 2.82), more than one extranodal involvement (RR = 1.69, 95% CI: 1.27 +/- 2.26), presence of B symptom (RR = 1.75, 95% CI: 1.30 +/- 2.35), non-germinal center B-cell subtype (RR = 1.35, 95% CI: 1.03 +/- 1.78), and elevated lactate dehydrogenase levels (RR = 1.30, 95% CI: 0.98 +/- 1.72). EBER positivity was correlated with worse outcomes, worse clinical course, and adverse clinicopathologic features among patients with DLBCL.