Clinical application of early gastric carcinoma with lymphoid stroma based on lymph node metastasis status

Epstein-Barr virus-associated gastric cancer (EBV-GC) accounts for approximately 8% of gastric cancers. However, little is known regarding intramucosal EBV-GC. The present study aimed to evaluate endoscopic and clinicopathological characteristics of intramucosal EBV-GC. Pathological data of 172 patients with 173 intramucosal gastric cancers who received gastrectomy with lymph node dissection were obtained for review. EBV-encoded small RNA in situ hybridization (EBER-ISH) was carried out using a tissue microarray block. Eight intramucosal early gastric cancers (4.6%) were EBER-ISH positive in which no cases had any lymph node metastasis. Macroscopic types were either depressed or flat, dominant histology was mixed type of moderate and poorly differentiated adenocarcinoma. In detail, histological features of "lace pattern" or "lymphocyte infiltration into the stroma or cancer nests" were observed.

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“…Regarding prevalence of LNM in intramucosal EBV‐GC, Tokunaga and Land reported none in 30 patients, and Lim et al . reported none in 32 patients.…”

Section: Discussionmentioning

confidence: 98%

Epstein–Barr virus positivity among surgically resected intramucosal gastric cancer

Murai

Kakushima

Sugino

et al. 2018

Digestive Endoscopy

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“…As noted, the GCLS incidence rate has been reported to be between 1% and 4% of all GC cases, and >80% of GCLS cases are associated with EBV infection . Prevalence of MSI‐H carcinoma in GCLS has been reported to range from 7% to 39% .…”

Section: Diagnostic Accuracy and Priority Between Ebvgc And Gclsmentioning

confidence: 92%

“…Epstein‐Barr virus‐associated gastric cancer has been reported to have clinically distinct characteristics, especially in terms of a favorable prognosis, because of the host inflammatory immune response with dense lymphocyte infiltration, particularly cytotoxic T lymphocytes . Furthermore, previous studies have reported that this phenotype shows a lower frequency of LNM in the early stage .…”

Section: Clinical Relevance Of Ebvgc For Early Gcmentioning

confidence: 99%

“…also reported the incidence of LNM for GCLS in early gastric cancer. Of 241 patients analyzed, 33 (13.7%) had pT1a cancers and 208 (86.3%) had pT1b cancers . Compared to the better differentiated adenocarcinoma (differentiated type) of an early phase, early GCLS was more prevalent in younger individuals and in men, tended to be proximally located, was highly associated with EBV infection (89.2%), and had a lower risk of LNM .…”

Section: Characteristics and Incidence Of Lnm In Gclsmentioning

confidence: 99%

“…Of 241 patients analyzed, 33 (13.7%) had pT1a cancers and 208 (86.3%) had pT1b cancers . Compared to the better differentiated adenocarcinoma (differentiated type) of an early phase, early GCLS was more prevalent in younger individuals and in men, tended to be proximally located, was highly associated with EBV infection (89.2%), and had a lower risk of LNM . Five‐year disease‐specific survival rate for patients with early GCLS was 98.3%; however, this depended significantly on LNM status ( P < 0.001) and EBV infection status ( P = 0.039) .…”

Section: Characteristics and Incidence Of Lnm In Gclsmentioning

confidence: 99%

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

Osumi

Kawachi

Yoshio

et al. 2020

Digestive Endoscopy

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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.

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Pathology of Advanced Gastric Cardiac Carcinoma Cancer

Huang

2018

Gastric Cardiac Cancer

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Clinical application of early gastric carcinoma with lymphoid stroma based on lymph node metastasis status

Abstract: Early GCLS has distinct clinicopathological features depending on age, sex, tumor location, EBV infection status, and LNM status. Tailored therapies, including endoscopic treatment, are needed based on the distinct clinicopathological features of early GCLS.

Cited by 29 publications

References 27 publications

Epstein–Barr virus positivity among surgically resected intramucosal gastric cancer

Epstein–Barr virus positivity among surgically resected intramucosal gastric cancer

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

Pathology of Advanced Gastric Cardiac Carcinoma Cancer

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