Cytomegalovirus and Lung Cancer: Evidence Beyond Any Reasonable Doubt?

Background:Human cytomegalovirus (HCMV) has been detected in various cancers, including lung adenocarcinoma. However, whether HCMV represents a sufficient condition for EGFR-mutated lung cancer remains unclear. This study re-analyses data from Harabajsa et al. (2023) to evaluate the relationship between HCMV infection and EGFR-mutated lung adenocarcinoma.Material and methods:We applied the Empirical Proportion Test (EPT), a nonparametric, parameter-free test based on a discrete uniform reference distribution over all possible success counts. The analysis included 67 patients with EGFR-mutated lung adenocarcinoma, all of whom tested positive for HCMV (\(k = 67\), \(n = 67\)). The right-tailed p-value was calculated under the null hypothesis that HCMV is not a sufficient condition.Results:The EPT without threshold yielded a right-tailed p-value of \(1/68 = 0.0147\). The exact binomial test with \(\pi_0 = 0.95\) produced a p-value of \(0.0322\). Both tests reject the null hypothesis at \(\alpha = 0.05\).Conclusion:With an error probability of \(p = 0.03\), we conclude that HCMV is a sufficient condition for EGFR-mutated lung cancer. This finding suggests that HCMV may be causally involved in lung cancer development.