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- Title
Epstein–Barr Virus and Clinico-Endoscopic Characteristics of Gastric Remnant Cancers Compared to Proximal Non-Remnant Cancers: A Population-Based Study.
- Authors
Bringeland, Erling A.; Våge, Christina; Ubøe, Ann A. S.; Sandø, Alina D.; Mjønes, Patricia; Fossmark, Reidar
- Abstract
Simple Summary: Epstein–Barr virus (EBV)-associated gastric cancer is accepted as a distinct entity among gastric adenocarcinomas. It is particularly frequent in gastric remnant cancer (GCR), defined as cancer in the gastric stump several decades after distal gastric resection for benign disease. Gastric cancer in the West is a comparatively rare disease, and most of the published data stem from the East. Using population-based data from the West spanning the years from 2001 to 2016, we were able to show that a significantly higher proportion of GRCs compared to non-GRC proximally located cancers were EBV-positive, even in the West. The mode of presentation and findings at upper endoscopy were more subtle and differed significantly from proximally located non-GRC cancers, possibly making the GRCs more difficult to diagnose. Epstein–Barr virus (EBV) is associated with 5–10% of gastric cancers and is recognized as a distinct molecular subtype. EBV positivity is particularly high in gastric remnant cancer (GRC), which may inform the mode of clinical presentation and findings at endoscopy. Most data are from the East, and the question remains how this applies to a Western cohort. We conducted a population-based study in Central Norway, 2001–2016. Patients with GRC (n = 78) and patients with non-GRC proximally located cancer and available tissue for EBV status (n = 116, control group) were identified from the Norwegian Cancer Registry. Relevant data were collected from the individual patient journals. EBV status was assessed using in situ hybridization. The median latency time from the distal gastrectomy to GRC was 37.6 (range 15.7–68.0) years. GRC more often presented with GI bleeding, 31.0% vs. 16.1%, p = 0.017, and at endoscopy more seldom with an ulcer, 19.7% vs. 38.2%, p = 0.012, or a tumour, 40.8% vs. 66.4%, p < 0.001. For GRC, 18.7% were EBV-positive compared to 6.0% among the controls, p = 0.006. EBV status was not associated with patient age, sex, or Lauren histological type. No difference in long-term survival rates between GRC and controls was found or between EBV-positive vs. -negative GRCs. In conclusion, a higher proportion of GRC cases, compared to controls, are EBV positive, indicating different causative factors. The mode of clinical presentation and findings at endoscopy were more subtle in the patients with GRC.
- Subjects
NORWAY; ADENOCARCINOMA; GASTRECTOMY; STOMACH tumors; GASTROINTESTINAL hemorrhage; STATISTICAL significance; RESEARCH funding; EPSTEIN-Barr virus diseases; ENDOSCOPIC surgery; SYMPTOMS; MANN Whitney U Test; CHI-squared test; DESCRIPTIVE statistics; EPSTEIN-Barr virus; KAPLAN-Meier estimator; LOG-rank test; TUMORS; DATA analysis software; ENDOSCOPY; DISEASE complications
- Publication
Cancers, 2024, Vol 16, Issue 11, p2000
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112000