Department of Pathology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
Department of Oncology of the Affiliated Changzhou Second People's Hospital of Nanjing Medical University, Changzhou, China.
BMC Gastroenterol. 2020 Aug 17;20(1):273. doi: 10.1186/s12876-020-01422-9.
Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma (EBV-GCLS) is a rare variant of early gastric carcinomas. Clinicopathological features of this variant remain obscure, especially in Chinese patients. Therefore, we collected EBV-GCLS cases and studied clinicopathology and prognosis.
By a retrospective review of 595 consecutive radical gastrectomies for early gastric carcinoma from 2006 to 2018, we identified 8 (1.3%, 8/595) EBV-GCLS cases. Clinicopathologic characteristics were compared between EBV-GCLSs and 109 conventional early gastric carcinomas, which were divided into intramucosal, SM1, and SM2 subgroups. The latter 2 subgroups were classified according to the submucosal invasion depth below or over 500 μm.
All 8 EBV-GCLSs occurred in male patients and invaded deep submucosa (SM2) without lymph node metastasis (LNM), four (50%) of which had synchronous non-gastric malignant tumors (3 gastric gastrointestinal stromal tumors and 1 primary clear cell renal cell carcinoma), and four (50%) arose in the proximal stomach. Compared to conventional early gastric carcinomas, EBV-GCLS was significantly more frequent with SM2 invasion, poor differentiation, and synchronous non-gastric carcinoma tumor, but not with age, gender, macroscopic type, location, size, perineural invasion, lymphovascular invasion, and pathologic stage. In invasion-depth stratified comparisons in the SM2 subgroup, the frequency of LNM in EBV-GCLS was significantly lower than that in conventional early gastric carcinomas (p < 0.05) and the 5-year survival rate of patients with EBV-GCLS was better than that with conventional early gastric carcinomas in 3 subgroups (100% vs 91.5, 85.7, 83.9%, respectively), although the differences did not reach a statistically significant level due to the small sample size. Significant differences among 4 subgroups were found in tumor grade, lymphovascular invasion, LNM, pathological stage, and synchronous tumor, but not in age, gender, macroscopic type, tumor size, location, perineural invasion.
Even with poor differentiation and SM2 invasion, EBV-GCLS showed very low risk of LNM and may be a candidate for endoscopic therapy such as endoscopic submucosal dissection.
EB 病毒相关的早期胃腺癌伴淋巴间质（EBV-GCLS）是一种罕见的早期胃癌变体。这种变体的临床病理特征仍不清楚，尤其是在中国患者中。因此，我们收集了 EBV-GCLS 病例，并研究了其临床病理和预后。
通过回顾性分析 2006 年至 2018 年连续 595 例根治性胃切除术治疗的早期胃癌病例，我们确定了 8 例（1.3%，8/595）EBV-GCLS 病例。比较了 EBV-GCLS 与 109 例常规早期胃癌之间的临床病理特征，后者根据黏膜下浸润深度分为黏膜内、SM1 和 SM2 亚组。后两个亚组根据黏膜下浸润深度是否超过 500μm 进行分类。
所有 8 例 EBV-GCLS 均发生于男性患者，均侵犯深部黏膜下层（SM2）且无淋巴结转移（LNM），其中 4 例（50%）有同步非胃恶性肿瘤（3 例胃胃肠间质瘤和 1 例原发性透明细胞肾细胞癌），4 例（50%）发生于近端胃。与常规早期胃癌相比，EBV-GCLS 更常伴有 SM2 浸润、低分化和同步非胃癌肿瘤，但与年龄、性别、大体类型、部位、大小、神经周围浸润、血管淋巴管浸润和病理分期无关。在 SM2 亚组的浸润深度分层比较中，EBV-GCLS 的 LNM 发生率明显低于常规早期胃癌（p<0.05），并且 EBV-GCLS 患者的 5 年生存率在 3 个亚组中优于常规早期胃癌（分别为 100%、91.5%、85.7%和 83.9%），尽管由于样本量小，差异未达到统计学显著性水平。在肿瘤分级、血管淋巴管浸润、LNM、病理分期和同步肿瘤方面，4 个亚组之间存在显著差异，但在年龄、性别、大体类型、肿瘤大小、部位和神经周围浸润方面无差异。
即使分化程度差且有 SM2 浸润，EBV-GCLS 的 LNM 风险也非常低，可能是内镜黏膜下剥离术等内镜治疗的候选方案。
