Host Inflammatory Response Predicts Survival of Patients With Epstein-Barr Virus-Associated Gastric Carcinoma
Host Inflammatory Response Predicts Survival of Patients With Epstein-Barr Virus-Associated Gastric Carcinoma
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DOI：
10.1053/j.gastro.2010.04.002
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发表时间：
2010-07-01
期刊：
影响因子：
29.4
通讯作者：
Kim, Sung
中科院分区：
文献类型：
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作者：
Song, Hye-Jong;Srivastava, Amitabh;Kim, Sung
背景与目的：胃上皮瘤样癌（LELC）是一种罕见的胃癌亚型，其生存率高于其他胃癌;大多数LELC病例与EB病毒（EBV）感染有关。我们研究了LELC的生存优势是否与EBV感染本身或相关的炎症免疫反应有关。方法：从1994年至2008年，确定了123例EBV相关的GC，并与405例EBV阴性的GC进行了比较。根据宿主炎症免疫反应的模式，将EBV相关GC细分为3种组织学亚型：典型LELC（n = 53，43.1%），克罗恩病样淋巴细胞反应（Crohn's disease like lymphocytic reaction，ELC）（n = 52，42.3%）和常规腺癌（n = 18，14.6%）。根治性切除的EBV阴性胃癌患者作为对照。采用单变量和多变量分析，Bonferroni校正。研究结果：EBV相关性胃癌患者肿瘤位于近端，N分期较低（P <0.0001），T分期较低（P = 0.02），且年龄大于对照组（P = 0.0003）。单变量分析显示，EBV相关胃癌患者的生存时间长于对照组（P <0.004）;在多变量分析中，考克斯比例风险的差异不显著。根据宿主细胞免疫应答对EBV相关GC进行分层显示，LELC和LELC + GCs患者的总生存时间（风险比分别为0.09和0.42）和无病生存期（风险比分别为0.05和0.46; P <0.02）显著延长。结论：EBV相关GC的预后取决于患者的炎症反应。LELC的定义应扩大到包括EBV相关的GCs伴LELC，因为这些GCs的预后与LELC相似。
BACKGROUND & AIMS: Lymphoepithelioma-like carcinoma (LELC) is a rare subtype of gastric carcinoma (GC) with a better survival rate than other GCs; most cases of LELC are associated with Epstein-Barr virus (EBV) infection. We investigated whether the survival advantage of LELC is related to the EBV infection itself or to associated inflammatory immune responses. METHODS: From 1994 to 2008, 123 EBV-associated GCs were identified and compared with 405 EBV-negative GCs. EBV-associated GCs were subclassified, based on the pattern of host inflammatory immune responses, into 3 histologic subtypes: typical LELC (n = 53, 43.1%), Crohn's disease-like lymphocytic reaction (CLR) (n = 52, 42.3%), and conventional adenocarcinoma (n = 18, 14.6%). Patients with curatively resected EBV-negative GC were controls. Univariate and multivariate analyses were used, with Bonferroni correction. RESULTS: Patients with EBV-associated GC had tumors of proximal location, lower N stage (P < .0001), and lower T stage (P = .02) and were older than controls (P = .0003). Upon univariate analysis, patients with EBV-associated GC had longer survival times than controls (P < .004); this difference was not significant in a multivariate analysis with Cox proportional hazards. Stratification of EBV-associated GCs by host cellular immune responses showed that patients with LELC and LELC + CLR have significantly longer overall survival time (hazard ratio, 0.09 and 0.42, respectively) and disease-free survival (hazard ratio, 0.05 and 0.46, respectively; P < .02). CONCLUSIONS: Prognosis of EBV-associated GCs depends on the patient's inflammatory response. The definition of LELC should be expanded to include EBV-associated GCs with CLR because these have a prognosis similar to LELC.