Clinical impact of Epstein‐Barr virus status on the incidence of lymph node metastasis in early gastric cancer

• Published in: Digestive endoscopy Vol. 32; no. 3; pp. 316 - 322
• Main Authors: Osumi, Hiroki, Kawachi, Hiroshi, Yoshio, Toshiyuki, Fujisaki, Junko
• Format: Journal Article
• Language: English
• Published: Australia 01-03-2020
• Subjects: Carcinoma - epidemiology; Carcinoma - secondary; Carcinoma - virology; early gastric cancer; Endoscopic Mucosal Resection; endoscopic submucosal dissection; Epstein-Barr Virus Infections - complications; Epstein‐Barr virus; gastric carcinoma with lymphoid stroma; Herpesvirus 4, Human; Humans; Incidence; lymph node metastasis; Lymphatic Metastasis; Stomach Neoplasms - epidemiology; Stomach Neoplasms - pathology; Stomach Neoplasms - virology; endoscopic submucosal dissection; Epstein-Barr virus; gastric carcinoma with lymphoid stroma; early gastric cancer; lymph node metastasis
• ISSN: 0915-5635; 1443-1661
• DOI: 10.1111/den.13584

Epstein‐Barr virus‐positive gastric cancer (EBVGC) comprises approximately 9% of all gastric cancers and is associated with a low prevalence of lymph node metastasis (LNM). Given that limited data concerning LNM in EBV‐related early GC are available, EBV status is not considered an indicator for endoscopic submucosal dissection (ESD). In this review, we focused on pT1 EBVGC and on gastric carcinoma with lymphoid stroma (GCLS), and discuss expanded ESD indications and curative resection criteria. In pT1b EBVGC, the incidence of LNM was low (6/180 patients, 3.3%; 95% confidence interval [CI] 1.2–7.1), especially in lymphovascular invasion‐negative EBVGC (1/109 patients, 0.9%). No patients with pT1a EBVGC had LNM (0/38 patients, 0%; 95% CI 0–7.6), even those who did not meet the current curative ESD criteria. Although the frequency of LNM in GCLS was low (5.0–10.6%), the incidence of LNM in non‐EBV GCLS was relatively high (10.0–20.0%); therefore, EBV status can be considered a more important factor than GCLS. In summary, the clinicopathological characteristics of EBVGC differ from those of conventional GC, and EBV negativity is a risk factor for LNM in early GC. Therefore, patients in this group are likely to be promising candidates for ESD, and we recommend that EBV status evaluation be included in early GC treatment guidelines.