title: Clinical significance of spasmolytic polypeptide-expressing metaplasia and intestinal metaplasia in Epstein-Barr virus-associated and Epstein-Barr virus-negative gastric cancer.
abstract: Spasmolytic polypeptide-expressing metaplasia (SPEM) and intestinal metaplasia (IM) have been recognized as neoplastic precursors in gastric carcinogenesis. We explored the relationship between SPEM and IM in Epstein-Barr virus-associated (EBVaGC) and Epstein-Barr virus-negative (EBVnGC) gastric cancer. Sixty-four EBVaGC and one hundred and fifty-four EBVnGC patients were included. EBV positivity was identified using Epstein-Barr virus-encoded RNA-1 in situ hybridization. SPEM was subclassified into absent, early, and advanced SPEM. Acute and chronic inflammation was graded as absent, mild, moderate, and marked. Univariate and multivariate logistic regression analyses were conducted to analyze the correlation between SPEM, IM, and inflammation. Our study revealed that SPEM was detected in 87.5% EBVaGC and 85.1% EBVnGC patients. Distribution of patients according to the SPEM classification was significantly different between EBVaGC and EBVnGC groups (P=.038). IM was observed less frequently in EBVaGC when compared with EBVnGC patients (P<.001). No difference was observed between EBVaGC and EBVnGC in the levels of acute and chronic inflammation. A positive correlation between IM and SPEM status was observed in both EBVaGC and EBVnGC patients. Furthermore, advanced SPEM was an independent influential factor to IM in EBVnGC (P=.013). In conclusion, SPEM was associated with both EBVaGC and EBVnGC more frequently than IM. Moreover, advanced SPEM had a stronger association with IM than early SPEM in EBVnGC. These results suggest that identification of SPEM should be used as a high-risk indicator for detecting early gastric carcinoma, and should be brought to the attention of pathologists and clinicians.
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China; Department of Pathology, Guangdong Provincial Hospital of TCM, Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Jian-Ning
authors.initials: JN
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Min
authors.initials: M
authors.lastname: Dong
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Zhi-Gang
authors.initials: ZG
authors.lastname: Zhang
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
authors.forename: Yi-Wang
authors.initials: YW
authors.lastname: Zhang
authors.affiliation: Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou 510080, China.
authors.forename: Jun-Yan
authors.initials: JY
authors.lastname: Wu
authors.affiliation: Department of Pathology, Guangzhou First Municipal People's Hospital, Guangzhou Medical University, Guangzhou 510180, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Du
authors.affiliation: Department of Pathology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
authors.forename: Hai-Gang
authors.initials: HG
authors.lastname: Li
authors.affiliation: Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China. Electronic address: chunkuishao2011@163.com.
authors.forename: Chun-Kui
authors.initials: CK
authors.lastname: Shao
mesh_terms: D000230:Adenocarcinoma / Q000737:chemistry* / Q000473:pathology / Q000601:surgery / Q000821:virology; D014408:Biomarkers, Tumor / Q000032:analysis*; D001706:Biopsy; D016009:Chi-Square Distribution; D002681:China; D020031:Epstein-Barr Virus Infections / Q000821:virology*; D005260:Female; D005756:Gastritis / Q000378:metabolism / Q000473:pathology / Q000821:virology; D004854:Herpesvirus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D017403:In Situ Hybridization; D036341:Intercellular Signaling Peptides and Proteins; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010455:Peptides / Q000032:analysis*; D011230:Precancerous Conditions / Q000737:chemistry* / Q000473:pathology / Q000601:surgery / Q000821:virology; D016016:Proportional Hazards Models; D012367:RNA, Viral / Q000235:genetics; D013270:Stomach / Q000737:chemistry* / Q000473:pathology / Q000821:virology; D013274:Stomach Neoplasms / Q000737:chemistry* / Q000473:pathology / Q000601:surgery / Q000821:virology
chemical_list: D014408:Biomarkers, Tumor; C099537:Epstein-Barr virus encoded RNA 1; D036341:Intercellular Signaling Peptides and Proteins; D010455:Peptides; D012367:RNA, Viral; C451060:spasmolytic polypeptide
keywords: EBVaGC; Epstein-Barr virus; Gastric carcinoma; Intestinal metaplasia (IM); Spasmolytic polypeptide-expressing metaplasia (SPEM)