Skip to content
2000
Volume 26, Issue 1
  • ISSN: 1871-5206
  • E-ISSN: 1875-5992

Abstract

Background

Herpes zoster (HZ) is a common complication in patients with malignant tumors (MT), impacting prognosis. Immunocompromised states due to malignancy or treatment increase HZ risk. However, comprehensive assessments of HZ's clinical features and its impact on prognosis in these patients are limited, general conclusions are challenging, prompting a systematic review and meta-analysis to better understand the relative risk of HZ in malignancy.

Objective

To assess the clinical features and prognostic factors of HZ in cancer patients through systematic review and meta-analysis. The study aimed to calculate the relative risk of HZ in malignancy and analyze factors affecting prognosis, such as age, gender, tumor type, and treatment.

Methods

A systematic search in PubMed (2016-2024) identified studies on HZ and malignancy. Two reviewers independently screened and selected studies, extracting data on study characteristics, population demographics, and outcomes. Statistical heterogeneity across the studies was addressed using random-effects models, while subgroup analyses were performed to identify potential sources of heterogeneity.

Results

Out of the 633 records reviewed, 13 studies satisfied the eligibility criteria and were incorporated into the meta-analysis. The combined relative risk for any type of cancer was found to be 1.82(95% CI: 1.29,2.57). The combined relative risk for any solid tumors was 1.63(95% CI: 1.08,2.46). The combined relative risk for any haematological cancer was 3.43(95% CI: 1.33,8.86). The combined analysis of all treatment modalities (including Radiotherapy, Chemotherapy, Immunosuppression, HSCT) shows a significant overall effect with a risk ratio of 1.78(95%CI: 1.59,2.00).

Conclusion

Cancer patients have increased HZ risk due to immunosuppression from the malignancy and its treatment, especially in hematological cancers and those undergoing stem cell transplantation.

© 2026 Bentham Science Publishers
Loading

Article metrics loading...

/content/journals/acamc/10.2174/0118715206350399250324183333
2025-04-07
2026-03-03

  • From This Site

    /content/journals/acamc/10.2174/0118715206350399250324183333
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

References

  1. CohenJ.I. Clinical practice.Herpes Zoster. N. Engl. J. Med.2013369325526310.1056/NEJMcp1302674 23863052
     [Google Scholar]
  2. GildenD.H. Kleinschmidt-DeMastersB.K. LaGuardiaJ.J. MahalingamR. CohrsR.J. Neurologic complications of the reactivation of varicella-zoster virus.N. Engl. J. Med.2000342963564510.1056/NEJM200003023420906 10699164
     [Google Scholar]
  3. LinH.C. ChaoY.H. WuK.H. YenT.Y. HsuY.L. HsiehT.H. WeiH.M. WuJ.L. MuoC.H. HwangK.P. PengC.T. LinC.C. LiT.C. Increased risk of herpes zoster in children with cancer.Medicine20169530e403710.1097/MD.0000000000004037 27472677
     [Google Scholar]
  4. WooY.R. JungY.J. KimJ.S. KimM. ParkY.M. MinC.K. KimD.W. ParkH.J. Cutaneous comorbidities in patients with multiple myeloma.Medicine20189743e1282510.1097/MD.0000000000012825 30412074
     [Google Scholar]
  5. AsadaH. VZV-specific cell-mediated immunity, but not humoral immunity, correlates inversely with the incidence of herpes zoster and the severity of skin symptoms and zoster-associated pain: The SHEZ study.Vaccine201937446776678110.1016/j.vaccine.2019.09.031 31543415
     [Google Scholar]
  6. LuL. SuoL. LiJ. PangX. A retrospective survey on herpes zoster disease burden and characteristics in Beijing, China.Hum. Vaccin. Immunother.201814111410.1080/21645515.2018.1489193 30059639
     [Google Scholar]
  7. PageM.J. MoherD. BossuytP.M. BoutronI. HoffmannT.C. MulrowC.D. ShamseerL. TetzlaffJ.M. AklE.A. BrennanS.E. ChouR. GlanvilleJ. GrimshawJ.M. HróbjartssonA. LaluM.M. LiT. LoderE.W. Mayo-WilsonE. McDonaldS. McGuinnessL.A. StewartL.A. ThomasJ. TriccoA.C. WelchV.A. WhitingP. McKenzieJ.E. PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews.BMJ2021372n16010.1136/bmj.n160 33781993
     [Google Scholar]
  8. StangA. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.Eur. J. Epidemiol.201025960360510.1007/s10654‑010‑9491‑z 20652370
     [Google Scholar]
  9. SchmidtS.A.J. MorA. SchønheyderH.C. SørensenH.T. DekkersO.M. Cronin-FentonD. Herpes zoster as a marker of occult cancer: A systematic review and meta-analysis.J. Infect.201774321523510.1016/j.jinf.2016.11.005 27845154
     [Google Scholar]
  10. GreenlandS. Quantitative methods in the review of epidemiologic literature.Epidemiol. Rev.19879113010.1093/oxfordjournals.epirev.a036298 3678409
     [Google Scholar]
  11. EggerM. SmithG.D. SchneiderM. MinderC. Bias in meta-analysis detected by a simple, graphical test.BMJ1997315710962963410.1136/bmj.315.7109.629 9310563
     [Google Scholar]
  12. BuchanS.A. DanemanN. WangJ. GarberG. WormsbeckerA.E. WilsonS.E. DeeksS.L. Incidence of hospitalizations and emergency department visits for herpes zoster in immunocompromised and immunocompetent adults in ontario, canada, 2002–2016.Clin. Infect. Dis.2020711222910.1093/cid/ciz769 31436814
     [Google Scholar]
  13. ChoiH.G. ZehnderJ.L. LeeY.K. LimH. KimM. Increased risk of lymphoid malignancy in patients with herpes zoster: A longitudinal follow-up study using a national cohort.BMC Cancer2019191114810.1186/s12885‑019‑6349‑y 31775678
     [Google Scholar]
  14. VázquezG.Y. CabanillasF. ConcepciónJ.R. MirandaD.O.L. Incidence and risk factors for developing herpes zoster among a cohort of patients diagnosed with lymphoma at a community cancer center.Clin. Lymphoma Myeloma Leuk.2019193e153e15810.1016/j.clml.2018.12.001 30655095
     [Google Scholar]
  15. KaoY.S. HsuY. HsuC. Radiotherapy increases the incidence of herpes zoster in oral cavity cancer patients – a national population-based cohort study.In Vivo20213563547355310.21873/invivo.12657 34697193
     [Google Scholar]
  16. KimY.J. LeeC.N. LeeM.S. LeeJ.H. LeeJ.Y. HanK. ParkY.M. Recurrence rate of herpes zoster and its Risk factors: A population-based cohort study.J. Korean Med. Sci.2019342e110.3346/jkms.2019.34.e1 30636941
     [Google Scholar]
  17. LeeP.Y. LaiJ.N. ChenS.W. LinY.C. ChiuL.T. WeiY.T. Radiotherapy combined with chemotherapy increases the risk of herpes zoster in patients with gynecological cancers: A nationwide cohort study.J. Gynecol. Oncol.2021322e1310.3802/jgo.2021.32.e13 33300312
     [Google Scholar]
  18. LiaoK.F. KuoY.H. LaiS.W. Increased risk of herpes zoster in cancer patients.J. Infect. Dis.201922091542154310.1093/infdis/jiz329 31242285
     [Google Scholar]
  19. MahaleP. YanikE.L. EngelsE.A. Herpes Zoster and Risk of Cancer in the Elderly U.S. Population. Cancer Epidemiol.Biomarkers Prev.2016251283510.1158/1055‑9965.EPI‑15‑1033 26578536
     [Google Scholar]
  20. QianJ. HeywoodA.E. KarkiS. BanksE. MacartneyK. ChantrillL. LiuB. Risk of herpes zoster prior to and following cancer diagnosis and treatment: A population-based prospective cohort study.J. Infect. Dis.2019220131110.1093/infdis/jiy625 30544213
     [Google Scholar]
  21. TsaoY.H. HsiehC.J. JuanY.S. LeeY.C. ShenJ.T. WangH.S. JhanJ.H. GengJ.H. Herpes zoster and the subsequent risk of prostate cancer in an Asian population.Medicine20209940e2244110.1097/MD.0000000000022441 33019427
     [Google Scholar]
  22. ShimizuguchiT. SekiyaN. HaraK. TaguchiA. NakajimaY. MiyakeY. ShibataY. TaguchiK. OgawaH. ItoK. KarasawaK. Radiation therapy and the risk of herpes zoster in patients with cancer.Cancer2020126153552355910.1002/cncr.32926 32412661
     [Google Scholar]
  23. MaoJ. McPheetersJ.T. FinelliL. Healthcare utilization and costs among patients with herpes zoster and solid tumor malignancy on chemotherapy.Medicine20179648e874610.1097/MD.0000000000008746 29310348
     [Google Scholar]
  24. HanssonE. ForbesH.J. LanganS.M. SmeethL. BhaskaranK. Herpes zoster risk after 21 specific cancers: Population-based case–control study.Br. J. Cancer2017116121643165110.1038/bjc.2017.124 28463961
     [Google Scholar]
  25. YanniE.A. FerreiraG. GuennecM. HahiE.Y. GhachiE.A. HaguinetF. EspieE. BiancoV. Burden of herpes zoster in 16 selected immunocompromised populations in England: A cohort study in the Clinical Practice Research Datalink 2000–2012.BMJ Open201886e02052810.1136/bmjopen‑2017‑020528 29880565
     [Google Scholar]
  26. YenikomshianM.A. GuignardA.P. HaguinetF. LaCasceA.S. SkarinA.T. TraheyA. KarnerP. DuhM.S. The epidemiology of herpes zoster and its complications in Medicare cancer patients.BMC Infect. Dis.201515110610.1186/s12879‑015‑0810‑6 25888128
     [Google Scholar]
  27. ChenS.Y. SuayaJ.A. LiQ. GalindoC.M. MisurskiD. BurstinS. LevinM.J. Incidence of herpes zoster in patients with altered immune function.Infection201442232533410.1007/s15010‑013‑0550‑8 24214127
     [Google Scholar]
  28. ForbesH.J. BhaskaranK. ThomasS.L. SmeethL. ClaytonT. LanganS.M. Quantification of risk factors for herpes zoster: Population based case-control study.BMJ2014348g291110.1136/bmj.g2911 25134101
     [Google Scholar]
  29. ImafukuS. MatsukiT. MizukamiA. GotoY. SouzaD.S. JégouC. BiancoV. RosillonD. ItoC. CurranD. HollK. Burden of herpes zoster in the japanese population with immunocompromised/chronic disease conditions: Results from a cohort study claims database from 2005–2014.Dermatol. Ther.20199111713310.1007/s13555‑018‑0268‑8 30456446
     [Google Scholar]
  30. JihJ.S. ChenY.J. LinM.W. ChenY.C. ChenT.J. HuangY.L. ChenC.C. LeeD.D. ChangY.T. WangW.J. LiuH.N. Epidemiological features and costs of herpes zoster in Taiwan: A national study 2000 to 2006.Acta Derm. Venereol.200989661261610.2340/00015555‑0729 19997693
     [Google Scholar]
  31. PinchinatS. Cebrián-CuencaA.M. BricoutH. JohnsonR.W. Similar herpes zoster incidence across Europe: Results from a systematic literature review.BMC Infect. Dis.201313117010.1186/1471‑2334‑13‑170 23574765
     [Google Scholar]
  32. FeldmanS. HughesW.T. KimH.Y. Herpes zoster in children with cancer.Arch. Pediatr. Adolesc. Med.1973126217818410.1001/archpedi.1973.02110190156009 4353308
     [Google Scholar]
  33. MenonB.S. MaziahW.W.M. Herpes zoster in children with cancer.Malays. J. Pathol.20012314748 16329548
     [Google Scholar]
  34. SorensenG.V. RosthOjS. WürtzM. DanielsenT.K. The epidemiology of herpes zoster in 226 children with acute lymphoblastic leukemia. Ped. Blood.Can.2011576993997https://pubmed.ncbi.nlm.nih.gov/21254379/
     [Google Scholar]
  35. GuessH.A. BroughtonD.D. MeltonL.J.III KurlandL.T. Epidemiology of herpes zoster in children and adolescents: A population-based study.Pediatrics198576451251710.1542/peds.76.4.512 3863086
     [Google Scholar]
  36. HabelL.A. RayG.T. SilverbergM.J. HorbergM.A. YawnB.P. CastilloA.L. QuesenberryC.P.Jr LiY. SadierP. TranT.N. The epidemiology of herpes zoster in patients with newly diagnosed cancer.Cancer Epidemiol. Biomarkers Prev.2013221829010.1158/1055‑9965.EPI‑12‑0815 23118142
     [Google Scholar]
  37. SmittenA.L. ChoiH.K. HochbergM.C. SuissaS. SimonT.A. TestaM.A. ChanK.A. The risk of herpes zoster in patients with rheumatoid arthritis in the United States and the United Kingdom.Arthritis Care Res.20075781431143810.1002/art.23112 18050184
     [Google Scholar]
  38. ThomasS.L. HallA.J. What does epidemiology tell us about risk factors for herpes zoster?Lancet Infect. Dis.200441263310.1016/S1473‑3099(03)00857‑0 14720565
     [Google Scholar]
  39. WuK.H. TsaiC. WuH.P. SieberM. PengC.T. ChaoY.H. Human application of ex vivo expanded umbilical cord-derived mesenchymal stem cells: Enhance hematopoiesis after cord blood transplantation.Cell Transplant.201322112041205110.3727/096368912X663533 24165586
     [Google Scholar]
  40. WuK.H. WuH.P. ChanC.K. HwangS.M. PengC.T. ChaoY.H. The role of mesenchymal stem cells in hematopoietic stem cell transplantation: From bench to bedsides.Cell Transplant.201322472372910.3727/096368912X655217 23068433
     [Google Scholar]
  41. LiY. AnZ. YinD. LiuY. HuangZ. XuJ. MaY. TuQ. LiQ. WangH. Disease burden due to herpes zoster among population aged ≥50 years old in china: A community based retrospective survey.PLoS One2016114e015266010.1371/journal.pone.0152660 27055179
     [Google Scholar]
  42. YangY. ChenR. XuJ. LiQ. XuX. HaS. SongW. TanJ. XuF. KanH. The effects of ambient temperature on outpatient visits for varicella and herpes zoster in Shanghai, China: A time-series study.J. Am. Acad. Dermatol.201573466066510.1016/j.jaad.2015.07.015 26277211
     [Google Scholar]
  43. GarnettG.P. CoxM.J. BundyD.A.P. DidierJ.M. CatharineJ.S. The age of infection with varicella-zoster virus in St Lucia, West Indies.Epidemiol. Infect.1993110236137210.1017/S0950268800068308 8386097
     [Google Scholar]
  44. HartP.H. NorvalM. ByrneS.N. RhodesL.E. Exposure to ultraviolet radiation in the modulation of human diseases.Annu. Rev. Pathol.2019141558110.1146/annurev‑pathmechdis‑012418‑012809 30125148
     [Google Scholar]
  45. HuangE. WellsC.A. 2014, The ground state of innate immune responsiveness is determined at the interface of genetic, epigenetic, and environmental influences.J. Immunol.931131910.4049/jimmunol.1303410
     [Google Scholar]
  46. MacGillivrayD.M. KollmannT.R. The role of environmental factors in modulating immune responses in early life.Front. Immunol.2014543410.3389/fimmu.2014.00434 25309535
     [Google Scholar]
/content/journals/acamc/10.2174/0118715206350399250324183333
Loading
Clinical Characteristics and Prognostic Factors Associated with Herpes Zoster in Patients with Malignant Tumors: A Systematic Review and Meta-analysis
Anti-Cancer Agents in Medicinal Chemistry 26, 45 (2026); https://doi.org/10.2174/0118715206350399250324183333
/content/journals/acamc/10.2174/0118715206350399250324183333
/content/journals/acamc/10.2174/0118715206350399250324183333
Loading

Data & Media loading...

Supplements

PRISMA checklist is available as supplementary material on the publisher’s website along with the published article. Supplementary material is available on the publisher's website along with the published article.

file format download Download

  • Article Type:     Research Article
Keyword(s): cancer patients; Herpes zoster; immune function; malignant tumors; meta-analysis; prognostic factors

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test