Herpes zoster is not associated with subsequent gastrointestinal cancer - data from over 200,000 outpatients in Germany

Sep 24, 2026

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Purpose: Gastrointestinal (GI) cancers pose a growing global health challenge, and viral reactivation has been implicated in GI tumor development. This study tested whether reactivation of varicella-zoster virus after herpes zoster predicts later diagnosis of GI cancer. Methods: A retrospective matched cohort of 103,123 patients with first-time herpes zoster (2005–2021) was propensity score matched to 103,123 without herpes zoster. Incidence was followed up to 10 years and assessed using Cox regression. Results: GI cancer incidence was similar between cohorts (p=0.548) and herpes zoster was not linked to increased risk (HR 0.97; 95% CI 0.89–1.05). Conclusion: No significant association was observed between herpes zoster infection and subsequent GI cancer.

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Journal of Cancer Research and Clinical Oncology (2023) 149:17115–17121 [https://doi.org/10.1007/s00432-023-05432-4](https://doi.org/10.1007/s00432-023-05432-4) Herpes zoster is not associated with subsequent gastrointestinal cancer: data from over 200,000 outpatients in Germany Catherine Leyh1,2 · Christoph Roderburg1,2 · Tom Luedde1,2 · Sven H. Loosen1,2 · Karel Kostev3 Received: 6 August 2023 / Accepted: 14 September 2023 / Published online: 27 September 2023 © The Author(s) 2023 Abstract Purpose Gastrointestinal (GI) cancers are an increasing global health challenge. Viral diseases play an important role in the development of GI cancers. For example, Epstein-Barr virus, which belongs to the human herpesvirus family, is a wellrecognized risk factor for the development of gastric cancer. The purpose of this study was to investigate a possible association between varicella-zoster virus reactivation and subsequent diagnosis of GI cancer. Methods In this retrospective cohort study, a total of 103,123 patients with a first diagnosis of herpes zoster (HZ) between 2005 and 2021 were propensity score matched to a cohort of 103,123 patients without HZ. Patient data was extracted from the Disease Analyzer database (IQVIA) . The incidence of GI cancer was compared as a function of HZ. Cox regression analysis was used to examine the association between HZ and GI cancer. Results Over a follow-up period of up to 10 years, the incidence of GI cancer did not differ between the two cohorts (HZ cohort 2.26 cases per 1000 patient-years vs. non-HZ cohort 2.37 cases per 1000 patient-years, p = 0.548) . In regression analysis, HZ was not associated with an increased risk of developing GI cancer (HR: 0.97; 95% CI 0.89–1.05). Furthermore, no significant effect of the presence of HZ on the incidence of different GI cancer entities was found. Conclusion In this retrospective cohort study consisting of well-matched patients, we observed no significant association between a HZ infection and the development of GI cancer during a long-term follow-up. Keywords Varicella zoster virus · Herpes zoster · Gastrointestinal cancer · Epidemiology · Malignancy Introduction Varicella-zoster virus (VZV) is a neurotropic virus that belongs to the human herpesvirus family. After primary infection, the virus persists in neural tissue for life (Patil | Catherine Leyh and Christoph Roderburg share first authorship. | | --- | | Sven H. Loosen and Karel Kostev authors share senior authorship. | * Christoph Roderburg Christoph.Roderburg@med.uni-duesseldorf.de * Sven H. Loosen [Sven.Loosen@med.uni-duesseldorf.de](Sven.Loosen@med.uni-duesseldorf.de) 1 Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany 2 Center for Integrated Oncology, Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany 3 IQVIA, Frankfurt, Germany et al. 2022) . Accordingly, VZV can cause two types of disease: (i) Chickenpox, the initial exogenous infection, and (ii) herpes zoster (HZ), the clinical manifestation of an endogenous reactivation of persistent latent VZV from sensory ganglia (Cohen 2013) . HZ is particularly common in the elderly. In addition, immunocompromised patients, such as those who have undergone organ transplantation, malignant disease or human immunodeficiency virus (HIV) infection, are particularly susceptible to HZ (Patil et al. 2022) . Gastrointestinal (GI) cancers account for approximately one quarter of all cancers worldwide and are responsible for 35% of all cancer-related deaths. With an aging general population, the incidence is expected to further increase over the next decades (Arnold et al. 2020) . An association between viruses and GI cancers is already well established for human papilloma virus (HPV) and Epstein-Barr virus (EPV), the latter of which also belongs to the human he

FAQs

What was the main purpose of this study?

To investigate whether reactivation of varicella-zoster virus after herpes zoster is associated with later diagnosis of gastrointestinal (GI) cancer.

How were the study groups constructed?

A retrospective cohort of 103,123 patients with first-time herpes zoster (2005–2021) was propensity score matched to 103,123 patients without herpes zoster.

Did herpes zoster increase the risk of subsequent GI cancer?

No. GI cancer incidence did not differ significantly between cohorts, and Cox regression showed no increased risk (HR 0.97; 95% CI 0.89–1.05).

What was concluded from the long-term follow-up?

In this well-matched retrospective cohort, herpes zoster infection showed no significant association with the development of GI cancer during up to 10 years of follow-up.

Sep 24, 2026

Uploaded by Franzy