Prognostic factors in Epstein-Barr virus-associated stage I-III gastric carcinoma: Implications for a unique type of carcinogenesis

• Published in: Oncology reports Vol. 32; no. 2; pp. 530 - 538
• Main Authors: HUANG, SHIH-CHIANG, NG, KWAI-FONG, CHEN, KUANG-HUA, HSU, JUN-TE, LIU, KENG-HAO, YEH, TA-SEN, CHEN, TSE-CHING
• Format: Journal Article
• Language: English
• Published: Greece D.A. Spandidos 01.08.2014; Spandidos Publications; Spandidos Publications UK Ltd
• Subjects: Aged; Analysis; Automation; Classification; Development and progression; Distribution; Epstein-Barr virus; Epstein-Barr Virus Infections - diagnosis; Epstein-Barr Virus Infections - surgery; Epstein-Barr Virus Infections - virology; Female; Gastric cancer; Genetic aspects; Health aspects; Herpesvirus 4, Human - genetics; Humans; Hybridization; Infections; lymph node ratio; Lymphatic Metastasis - pathology; Lymphatic system; lymphoepithelioma-like carcinoma; Male; Medical prognosis; Middle Aged; Multivariate analysis; Neoplasm Invasiveness - pathology; Patients; Prognosis; Risk factors; RNA, Small Untranslated - genetics; RNA, Viral - genetics; Statistical analysis; Stomach cancer; Stomach Neoplasms - diagnosis; Stomach Neoplasms - pathology; Stomach Neoplasms - virology; Studies; Survival Analysis; tumor size; Tumors; Variables; Taiwan
• ISSN: 1021-335X; 1791-2431
• DOI: 10.3892/or.2014.3234

Epstein-Barr virus-associated gastric carcinoma (EBVaGC) has distinct clinicopathological features. However, the prognostic factors remain unclear, particularly in UICC/AJCC stage I-III cancer. We retrospectively enrolled 1,020 patients with stage I-III gastric cancer that received radical gastrectomy with lymphadenectomy. Formalin-fixed, paraffin-embedded surgical specimens were retrieved to construct tissue microarrays. EBV positivity was identified by in situ hybridization with EBV-encoded small RNA, and the histological classification was reviewed. Fifty-two cases of EBVaGC were identified, exhibiting a male predominance (p=0.003), a higher prevalence in stump cancer (p<0.001), and poorly differentiated carcinoma (p=0.010) compared with the controls. The survival analysis revealed no difference in survival between the EBVaGC cases and the EBV-negative cases (p=0.977). The multivariate analysis showed that EBVaGC cases with a tumor size >5 cm, non-lymphoepithelioma-like carcinoma (LELC), or a lymph node ratio >0.15 had a worse overall survival (hazard ratio 2.884, 12.178 and 19.352; p=0.027, 0.005 and <0.0001, respectively). The depth of tumor invasion and the number of lymph node metastases did not reach statistical significance (p=0.834 and 0.833, respectively). These prognostic factors, tumor size, LELC classification and lymph node ratio, may reflect a unique type of carcinogenesis of EBVaGC and may be considered when selecting high-risk patients for adjuvant treatment.