Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
Clin Gastroenterol Hepatol. 2015 Oct;13(10):1738-1744.e2. doi: 10.1016/j.cgh.2015.04.015. Epub 2015 Apr 23.
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.
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.
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.
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.
淋巴上皮瘤样胃癌（GCLS）是一种独特的胃癌组织学亚型，其特征为未分化癌与显著的淋巴浸润混合存在。超过 80%的 GCLS 病例与 EBV 感染相关，但尚不清楚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。
我们对 274 例（平均年龄 56.8 岁，85.4%为男性）基于病理学发现于 1998 年 3 月至 2012 年 12 月在韩国首尔的 Asan 医疗中心诊断为 GCLS 的患者进行了回顾性分析。我们将他们的数据与 822 例年龄和性别匹配的接受胃腺癌切除术的患者的数据进行了比较。通过原位杂交检测肿瘤样本中的 EBV。
在 274 例 GCLS 患者中，236 例（86.1%）的肿瘤为 EBV 阳性，38 例（13.9%）的肿瘤为 EBV 阴性。在年轻患者中，EBV 阳性 GCLS 比 EBV 阴性 GCLS 更为常见，倾向于位于近端，并且更常为早期大体类型。EBV 阳性 GCLS 患者的 10 年疾病特异性生存率为 89.1%，而 EBV 阴性 GCLS 患者的生存率为 66.9%（P=0.009）。EBV 阴性 GCLS 患者的临床和病理特征及生存时间与常规腺癌患者相似。通过多变量分析，较长的生存时间与 EBV 阳性肿瘤相关（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）以及无淋巴血管侵犯（P=0.012）。未分化肿瘤细胞的比例与患者生存时间无显著相关性。
GCLS 的临床和病理特征根据 EBV 感染状态而异。EBV 阴性 GCLS 与常规腺癌相似，患者的生存时间相似。在 GCLS 的诊断和患者管理中，EBV 状态可能比未分化肿瘤细胞的比例更为重要。
