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

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 end...

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Bibliographic Details
Published in:Digestive endoscopy 2020-03, Vol.32 (3), p.316-322
Main Authors: Osumi, Hiroki, Kawachi, Hiroshi, Yoshio, Toshiyuki, Fujisaki, Junko
Format: Article
Language:English
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
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Summary: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.
ISSN:0915-5635
1443-1661
DOI:10.1111/den.13584