Risk stratification for lymph node metastasis using Epstein-Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study
Risk stratification for lymph node metastasis using Epstein-Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study
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DOI：
10.1007/s10120-019-00963-7
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发表时间：
2019-11-01
期刊：
影响因子：
7.4
通讯作者：
Fujisaki, Junko
中科院分区：
文献类型：
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作者：
Osumi, Hiroki;Kawachi, Hiroshi;Fujisaki, Junko
背景 淋巴血管侵犯（LVI）是早期胃癌（GC）淋巴结转移（LNM）的强预测因素。本研究基于 Epstein-Barr 病毒 (EBV) 状态以及常规临床病理学参数，调查了无 LVI 的 pT1b GC 中 LNM 的风险。方法 回顾性分析 2005 年至 2014 年间在三个高容量中心接受手术的连续 847 例不伴有 LVI 的 pT1b GC 患者。评估临床病理参数和 EBV 状态，并进行单变量和多变量分析来估计 LNM 风险。关于这三个参数的存在，对 LNM 进行了风险分层，并与之前提出的风险分类进行了比较，其中包括低风险 (LNM < 3.0%)、中风险 (LNM >= 3.0 且 < 19.6%) 和高风险 (LNM >= 19.6%) 组。结果 EBV阳性GC（EBVGC）占病例的11.3%（847例中有96例）； EBVGC 中的 LNM 低于非 EBVGC（96 例中有 1 例，1.0% vs. 71/751，9.5%）。在多变量分析中，非 EBVGC [比值比 (OR) 10.8，95% 置信区间 (CI) 1.48-78.9]、年龄 < 65 岁（OR 2.13，95% CI 1.30-3.48）和肿瘤直径 > 3 cm（OR 2.26，95% CI 1.36-3.74）是独立危险因素LNM。 EBVGC 患者发生 LNM 的风险较低，而具有所有三个独立危险因素的患者则处于高风险（168 例中的 36 例，21.4%，95% CI 15.5-28.4）。结论 包括 EBV 状态的 LNM 风险分层有助于无 LVI 的 pT1b GC 病例的临床决策。
Background Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein-Barr virus (EBV) status in addition to conventional clinicopathological parameters. Methods In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM < 3.0%), intermediate-risk (LNM >= 3.0 and < 19.6%), and high-risk (LNM >= 19.6%) groups. Results EBV-positive GC (EBVGC) accounted for 11.3% (96 of 847) of cases; LNM was lower in EBVGC than in non-EBVGC (1 of 96, 1.0% vs. 71/751, 9.5%). In the multivariate analysis, non-EBVGC [odds ratio (OR) 10.8, 95% confidence interval (CI) 1.48-78.9], age < 65 years (OR 2.13, 95% CI 1.30-3.48), and tumor diameter > 3 cm (OR 2.26, 95% CI 1.36-3.74) were independent risk factors for LNM. Patients with EBVGC were at low risk for LNM whereas those with all of three independent risk factors were at high risk (36 of 168, 21.4%, 95% CI 15.5-28.4). Conclusion LNM risk stratification that includes EBV status is useful for clinical decision-making in pT1b GC cases without LVI.