Tokunaga M, Land C E
Department of Public Health, Kagoshima University School of Medicine, Sakuragaoka, Japan.
Cancer Epidemiol Biomarkers Prev. 1998 May;7(5):449-50.
EBV involvement in gastric cancer is characterized by episomal monoclonality, high antibody titers, EBV encoded small RNA and EBV nuclear antigen 1 expression in all tumor cells, and in the intramucosal stage, by a unique morphology. EBV involvement varies by population (approximately 7% of gastric cancers in Japan and >15% in Western countries), sex, histological type, and tumor location. The present study compares frequency of lymph node metastasis (LNM) between 170 EBV-positive and 1590 EBV-negative gastric cancer cases in Japan by level of invasiveness. Frequency of LNM increased with increasing depth of invasiveness but was consistently and significantly greater for EBV-negative cases (P = 0.0018). In particular, there were no instances of LNM among 75 EBV-positive cases as compared with 53 among 562 EBV-negative cases restricted to the mucosa and submucosa (odds ratio, 0; 95% confidence limits, 0-0.20). The finding suggests that genetic control of metastasis may differ between EBV-related and other gastric cancers. Also, the possibility that EBV-positive, noninvasive gastric cancers may not require lymph node dissection suggests that routine assay of biopsy specimens for EBV involvement could be important in populations, like that of Japan, where early gastric cancers are seen frequently.
EBV与胃癌的关联特征为游离型单克隆性、高抗体滴度、所有肿瘤细胞中EBV编码的小RNA和EBV核抗原1表达，在黏膜内阶段还具有独特形态。EBV的累及情况因人群（日本约7%的胃癌、西方国家>15%的胃癌）、性别、组织学类型和肿瘤位置而异。本研究按浸润程度比较了日本170例EBV阳性和1590例EBV阴性胃癌病例的淋巴结转移（LNM）频率。LNM频率随浸润深度增加而升高，但EBV阴性病例始终显著更高（P = 0.0018）。特别是，75例EBV阳性病例中无LNM实例，而562例局限于黏膜和黏膜下层的EBV阴性病例中有53例出现LNM（优势比为0；95%置信区间为0 - 0.20）。这一发现表明，EBV相关胃癌和其他胃癌在转移的遗传控制方面可能存在差异。此外，EBV阳性的非浸润性胃癌可能无需进行淋巴结清扫，这表明对于像日本这样早期胃癌常见的人群，对活检标本进行EBV累及情况的常规检测可能很重要。
