title: Meta-analysis of studies analyzing the role of human papillomavirus in the development of bladder carcinoma.
abstract: OBJECTIVE
  We aimed to ascertain the degree of association between bladder cancer and human papillomavirus (HPV) infection.
  
  
  METHODS
  We performed a meta-analysis of observational studies with cases and controls with publication dates up to January 2011. The PubMed electronic database was searched by using the key words "bladder cancer and virus." Twenty-one articles were selected that met the required methodological criteria. We implemented an internal quality control system to verify the selected search method. We analyzed the pooled effect of all the studies and also analyzed the techniques used as follows: 1) studies with DNA-based techniques, among which we found studies with polymerase chain reaction (PCR)-based techniques and 2) studies with non-PCR-based techniques, and studies with non-DNA-based techniques.
  
  
  RESULTS
  Taking into account the 21 studies that were included in the meta-analysis, we obtained a heterogeneity chi-squared value of Q(exp)=26.45 (p=0.383). The pooled odds ratio (OR) was 2.13 (95% confidence interval [CI], 1.54 to 2.95), which points to a significant effect between HPV and bladder cancer. Twenty studies assessed the presence of DNA. The overall effect showed a significant relationship between virus presence and bladder cancer, with a pooled OR of 2.19 (95% CI, 1.40 to 3.43). Of the other six studies, four examined the virus's capsid antigen and two detected antibodies in serum by Western blot. The estimated pooled OR in this group was 2.11 (95% CI, 1.27 to 3.51), which confirmed the relationship between the presence of virus and cancer.
  
  
  CONCLUSIONS
  The pooled OR value showed a moderate relationship between viral infection and bladder tumors.
authors.affiliation: Department of Urology, Santa Ana Hospital, Granada, Spain. anjipa29@hotmail.com
authors.forename: Antonio
authors.initials: A
authors.lastname: Jimenez-Pacheco
authors.forename: Manuela
authors.initials: M
authors.lastname: Exposito-Ruiz
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Arrabal-Polo
authors.forename: Alfonso J
authors.initials: AJ
authors.lastname: Lopez-Luque