Features of Gastric Carcinoma With Lymphoid Stroma Associated With Epstein-Barr Virus
Features of Gastric Carcinoma With Lymphoid Stroma Associated With Epstein-Barr Virus
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DOI：
10.1016/j.cgh.2015.04.015
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发表时间：
2015-10-01
影响因子：
12.6
通讯作者：
Kim, Byung Sik
中科院分区：
文献类型：
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作者：
Lim, Hyun;Park, Young Soo;Kim, Byung Sik
背景与目的：胃癌伴淋巴样间质（GCLS）是一种独特的组织学亚型胃癌，其特征是未分化癌伴显著淋巴样浸润。超过80%的GCLS病例与eb病毒（EBV）感染有关，但尚不清楚该病毒是否影响疾病进展。我们研究了EBV感染如何影响GCLS的临床和病理特征，以及患者的预后。方法：我们对1998年3月至2012年12月在韩国首尔峨山医疗中心诊断为GCLS的274例患者（平均年龄56.8岁，85.4%为男性）进行了回顾性分析。他们的数据与822名年龄和性别匹配的胃腺癌切除术患者的数据进行了比较。用原位杂交法在肿瘤样品中检测EBV。结果：274例GCLS患者中ebv阳性肿瘤236例（86.1%），ebv阴性肿瘤38例（13.9%）。ebv阳性GCLS在年轻患者中比ebv阴性GCLS更普遍，倾向于位于近端，并且更常为早期宏观类型。ebv阳性GCLS患者的10年疾病特异性生存率为89.1%，ebv阴性GCLS患者的10年疾病特异性生存率为66.9% （P = 0.009）。ebv阴性GCLS患者的临床、病理特征和生存时间与常规腺癌患者相似。通过多因素分析，ebv阳性肿瘤（P = 0.007）、患者年龄较小（P = 0.002）、肿瘤体积较小（P = 0.046）、分期较低（基于美国癌症联合委员会分类，P < 0.001）、缺乏淋巴血管侵袭（P = 0.012）与生存时间较长相关。未分化肿瘤细胞比例与患者生存时间无显著相关性。结论：EBV感染情况不同，GCLS的临床和病理特征也不同。ebv阴性的GCLS与常规腺癌相似，患者的生存时间相似。在GCLS的诊断和患者的治疗中，EBV状态可能比未分化肿瘤细胞的比例更重要。
BACKGROUND & AIMS: Gastric carcinoma with lymphoid stroma (GCLS) is a distinct histologic subtype of gastric cancer that is characterized by undifferentiated carcinoma mixed with prominent lymphoid infiltration. More than 80% of GCLS cases are associated with Epstein-Barr virus (EBV) infection, but it is unclear if the virus affects disease progression. We investigated how EBV infection affects the clinical and pathologic features of GCLS, as well as patients' outcomes.METHODS: We performed a retrospective analysis of 274 patients (mean age, 56.8 y; 85.4% male) diagnosed with GCLS, based on pathology findings, from March 1998 through December 2012 at the Asan Medical Center in Seoul, South Korea. Their data were compared with those from 822 age-and sex-matched patients who underwent resection for gastric adenocarcinoma. EBV was detected in tumor samples by in situ hybridization.RESULTS: Of the 274 patients with GCLS, 236 had EBV-positive tumors (86.1%) and 38 had EBV-negative tumors (13.9%). EBV-positive GCLS was more prevalent than EBV-negative GCLS in younger patients, tended to be located proximally, and was more frequently of an early stage macroscopic type. The 10-year, disease-specific rates of survival were 89.1% for patients with EBV-positive GCLS and 66.9% for patients with EBV-negative GCLS (P = .009). Patients with EBV-negative GCLS had clinical and pathologic features and survival times similar to those of patients with conventional adenocarcinoma. By multivariate analysis, longer survival time was associated with EBV-positive tumors (P = .007), younger patient age (P = .002), smaller tumor size (P = .046), lower stage (based on American Joint Committee on Cancer classification; P < .001), and lack of lymphovascular invasion (P = .012). The proportion of undifferentiated tumor cells was not associated significantly with patient survival time.CONCLUSIONS: Clinical and pathologic features of GCLS differ based on EBV infection status. EBV-negative GCLS is similar to conventional adenocarcinoma, and patients have similar survival times. EBV status may be more important than the proportion of undifferentiated tumor cells in the diagnosis of GCLS and management of patients.