EB病毒相关性胃癌的病理学特征及手术治疗对其临床预后的影响

Analysis of pathological features of epstein-barr virus-associated gastric cancer and exploration of the role of radical gastrectomy in its clinical prognosis

目的探讨EB病毒(EBV)相关性胃癌的病理学特征及手术治疗对临床预后的影响。方法收集浙江省肿瘤医院2015年1月1日至2017年12月31日期间明确诊断EBV相关性胃癌的21例住院患者病理样本,研究其病理形态学特征,并分析手术治疗及术后辅助治疗与其临床预后的相关性。应用GraphPad Prism 8统计软件分析,采取Log-rank检验及单因素Cox风险模型分析,应用SPSS 19.0统计软件对各种因素进行之间的相关性进行Spearman相关分析。结果形态学上21例患者中12例患者肿瘤间质内大量的淋巴细胞浸润,9例患者缺乏丰富的淋巴细胞浸润。6例死亡,总生存率为71.43%。生存分析发现间质富于淋巴细胞的EBV相关性胃癌患者预后显著优于间质无显著淋巴细胞浸润者,差异有统计学意义(P<0.01);5例患者存在神经累犯,有神经侵犯者较无神经侵犯者预后明显差,差异有统计学意义(P<0.05);20例患者接受胃癌根治术,1例接受内窥镜下肿瘤切除,9例接受术后化疗,4例患者接受术后局部调强放疗;生存分析提示术后辅助放疗、化疗对临床预后无明显改善。结论间质富于淋巴细胞是EBV相关性胃癌的良好预后因素,肿瘤侵犯神经提示不良预后。根治性手术切除是EBV相关胃癌的主要治疗手段,术后辅助放化疗未明显改善其临床预后。

Objective To study the pathological features of epstein-barr virus (EBV)-associated gastric cancer and analyze role of radical resection in its clinical prognosis. Methods The pathological and clinical data of 21 patients with EBV-associated gastric cancer admitted to Zhejiang Cancer Hospital from January 1, 2015 to December 31, 2018 were collected. The pathological features and therapeutic effects were retrospectively analyzed. Results Morphological analysis found 12 patients with abundant lymphocytes infiltrating in the stroma, and 9 patients lacked lymphocyte infiltration. Survival analysis found that survival of patients with lymphocyte-rich stroma was significantly better than that of patients with few lymphocytic infiltration (P<0.01);5 cases have pathological features of tumor invaded nerve fiber. Those with tumor invaded nerve had a significantly worse prognosis than those without (P<0.05). 20 cases received radical gastrectomy, 1 case of early stage received ESD tumor resection, 9 cases received postoperative chemotherapy, 4 cases received postoperative adjuvant radiotherapy. There was no obvious correlation between radiotherapy, chemotherapy and prognosis. Conclusion Abundant lymphocytes infiltrating in the stroma Interstitial enrichment of lymphocytes is a preferable prognostic factor for patients with EBV-associated gastric cancer. Tumor with invaded nerve indicates compromised prognosis. Radical resection is the main treatment for EBV-related gastric cancer. Postoperative adjuvant chemotherapy or radiotherapy does not improve prognosis.