Epstein-Barr virus infection serves as an independent predictor of survival in patients with lymphoepithelioma-like gastric carcinoma.
BACKGROUND
The pathogenesis and clinicopathologic characteristics of Epstein-Barr virus (EBV)-negative lymphoepithelioma-like gastric carcinoma (LELC) are still unclear. In addition, it remains controversial whether EBV infection itself affects the prognosis of LELC.


METHODS
Between 1995 and 2011, 145 LELC patients (124 patients with EBV infection and 21 patients without EBV infection) underwent radical gastrectomy with D2 lymph node dissection. The clinicopathologic features and prognosis of EBV-negative LELC cases were compared with those of EBV-positive LELC cases. The median duration of follow-up after surgery was 55 months. Microsatellite instability (MSI) analysis was performed on 20 EBV-negative LELC cases.


RESULTS
EBV-negative LELC accounted for 14.5 % of the total LELC cases. EBV-negative LELC was significantly associated with older age, female sex, advanced T stage, and advanced American Joint Committee on Cancer (AJCC) tumor stage compared with EBV-positive LELC. In univariate analysis, patients with EBV-negative LELC had significantly shorter overall, disease-specific, and recurrence-free survival than those with EBV-positive LELC. The 5-year overall survival rates were 81.0 % for patients with EBV-negative LELC and 96.2 % for patients with EBV-positive LELC. In a Cox proportional hazards model, EBV infection, age, and AJCC tumor stage were identified as independent predictors of overall survival. MSI-high, MSI-low, and microsatellite-stable tumors accounted for 25, 10, and 65 % of EBV-negative LELC cases, respectively. MSI status did not affect the prognosis of EBV-negative LELC cases.


CONCLUSIONS
EBV infection serves as an independent predictor of survival in patients with LELC. EBV-negative LELC exhibited clinicopathologic features and prognosis distinct from those of EBV-positive LELC.
Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Byung-Hoon
BH
Min
Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
Chung Hyun
CH
Tae
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
Soo Min
SM
Ahn
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea.
So Young
SY
Kang
Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea.
Sook-Young
SY
Woo
Biostatistics Team, Samsung Biomedical Research Institute, Seoul, Korea.
Seonwoo
S
Kim
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea. kkmkys@skku.edu.
Kyoung-Mee
KM
Kim
D000230:Adenocarcinoma / Q000401:mortality* / Q000556:secondary / Q000821:virology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002277:Carcinoma / Q000401:mortality* / Q000473:pathology / Q000821:virology; D020031:Epstein-Barr Virus Infections / Q000401:mortality* / Q000473:pathology / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D004854:Herpesvirus 4, Human; D006801:Humans; D008207:Lymphatic Metastasis; D008214:Lymphocytes / Q000473:pathology* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000821:virology; D015996:Survival Rate
Epstein–Barr virus; Lymphoepithelioma-like gastric carcinoma; Prognosis