Epstein–Barr virus status is a promising biomarker for endoscopic resection in early gastric cancer: proposal of a novel therapeutic strategy
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Epstein–Barr virus-positive gastric cancer (EBVGC) is associated with a low prevalence of lymph node metastasis (LNM); however, EBV status is not considered in the indication of endoscopic resection (ER). We aimed to clarify the implication of EBV status for ER of pT1b GC.
Consecutive cases of pT1b GCs treated with surgery between 2005 and 2014 were retrospectively analyzed. Clinicopathological factors and LNM status were compared between EBVGC and non-EBVGC groups.
EBVGC accounted for 7.9% (71 of 898) cases. Compared to non-EBVGC, EBVGC was more frequent in males (p = 0.0055), the upper third region (p < 0.0001), showed elevated growth features (p = 0.0059), and was associated with a lower frequency of accompanying ulceration (p = 0.002), greater depth of submucosal invasion (p = 0.017), and lower frequency of lymphatic invasion (p < 0.0001). Frequency of LNM was significantly lower in EBVGC than in non-EBVGC (4.2% vs. 21.9%, p < 0.0001). In EBVGC, tumors without lymphovascular invasion showed significantly lower frequency of LNM than those with lymphovascular invasion (0 of 50, 0%; vs 3 of 21, 14.3%; p = 0.023). Histologically, 84.5% (60 of 71) of EBVGC included carcinomas with lymphoid stroma and/or lace pattern components.
pT1b EBVGC is a convincing candidate for ER, regardless of risk factors other than lymphovascular invasion.
KeywordsGastric carcinoma pT1b Epstein–Barr virus Lymph node metastasis
We are grateful to Ms. Miyuki Kogure, Mr. Motoyoshi Iwakoshi, Ms. Tomoyo Kakita, Ms. Miki Hatta, Mr. Shuhei Ishii, and Ms. Naoko Takahashi for their excellent technical support. We also thank Dr. Maki Kobayashi for strong support and advice regarding the histologic analysis.
Conception and design: HO, HK, TY and JF; acquisition of data: HO; analysis and interpretation of data: HO, HK, TY; writing, review and/or revision of the manuscript: all authors; administrative, technical or material support: HK and NY; study supervision: JF.
This research was supported by the Daiwa Securities Health Foundation and JSPS KAKENHI Grant number JP16K08661.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Institutional Review Board, approval number 2017-1078) and with the Helsinki Declaration.
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