Departments of, Department of, Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Dig Endosc. 2021 May;33(4):592-597. doi: 10.1111/den.13823. Epub 2020 Oct 19.
Epstein-Barr virus-associated gastric cancer (EBVGC) has been reported to be associated with a low risk for lymph node metastasis (LNM). However, the curative criteria for endoscopic submucosal dissection (ESD) for submucosal EBVGC (pT1b-EBVGC) remain unclear. Our study aimed to investigate the risk factors for LNM in pT1b-EBVGC.
This was a retrospective multicenter study at five institutes in Japan. We reviewed medical records and extracted all pT1b-EBVGC cases that met the following criteria: (i) histologically proven submucosal gastric cancer; (ii) surgical or endoscopic resection between January 2000 and December 2016; and (iii) presence of Epstein-Barr virus (EBV) in tumor cells verified by EBV-encoded small RNA in situ hybridization (EBER-ISH). The association between clinicopathological factors and LNM were assessed using multivariable logistic regression analysis.
A total of 185 pT1b-EBVGC cases were included in the analysis. LNM was found in nine cases (4.9%). Multivariable logistic regression analysis demonstrated that lymphatic invasion (OR 9.1; 95% CI 2.1-46.1) and submucosal invasion ≥4000 μm (OR 9.2; 95% CI 1.3-110.3) were significant risk factors for LNM. When we focused on pT1b-EBVGC without lymphatic invasion and with submucosal invasion <2000 μm, the rate of LNM was 0% (0/96, 95% CI 0-3.8%).
Our findings indicated that lymphatic invasion and submucosal invasion ≥4000 μm were significant risk factors for LNM. ESD could be an appropriate option for pT1b-EBVGC without lymphatic invasion and with submucosal invasion <2000 μm.
已报道与 EBV 相关的胃癌（EBVGC）淋巴结转移（LNM）风险较低。然而，对于黏膜下 EBVGC（pT1b-EBVGC）内镜黏膜下剥离术（ESD）的治愈标准仍不清楚。本研究旨在探讨 pT1b-EBVGC 中 LNM 的危险因素。
这是日本五家机构的回顾性多中心研究。我们复习了病历并提取了所有符合以下标准的 pT1b-EBVGC 病例：（i）组织学证实的黏膜下胃癌；（ii）2000 年 1 月至 2016 年 12 月期间进行的手术或内镜切除；和（iii）肿瘤细胞中存在 EBV 通过 EBV 编码的小 RNA 原位杂交（EBER-ISH）证实。使用多变量逻辑回归分析评估临床病理因素与 LNM 的相关性。
共纳入 185 例 pT1b-EBVGC 病例进行分析。9 例（4.9%）发现 LNM。多变量逻辑回归分析表明，淋巴管浸润（OR 9.1；95%CI 2.1-46.1）和黏膜下浸润≥4000μm（OR 9.2；95%CI 1.3-110.3）是 LNM 的显著危险因素。当我们关注无淋巴管浸润且黏膜下浸润<2000μm 的 pT1b-EBVGC 时，LNM 发生率为 0%（0/96，95%CI 0-3.8%）。
我们的研究结果表明，淋巴管浸润和黏膜下浸润≥4000μm 是 LNM 的显著危险因素。对于无淋巴管浸润且黏膜下浸润<2000μm 的 pT1b-EBVGC，ESD 可能是一种合适的选择。
