Clinical Significance of Epstein-Barr Virus and Helicobacter pylori Infection in Gastric Carcinoma

Abstract

Background/Aims Epstein-Barr virus (EBV) and Helicobacter pylori (HP) coinfection may synergistically induce severe inflammatory responses in the stomach tissue, increasing the risk of developing gastric cancer. We aimed to analyze the effect of EBV and HP coinfection on the clinicopathologic features and prognosis of gastric cancer, as well as to evaluate the role of EBV infection in non-gastric carcinoma with lymphoid stroma (non-GCLS). Methods Overall, 956 patients who underwent surgery for gastric cancer between September 2014 and August 2015 were eligible and divided into groups, according to GCLS morphology, EBV infection, and HP infection. Clinicopathologic characteristics and oncologic outcomes were analyzed retrospectively. Results EBV and HP coinfection was significantly associated with male sex, proximal location, GCLS morphology, and equivocal p53 expression (p<0.001). Multivariate analysis revealed that EBV infection alone (hazard ratio [HR], 0.362; 95% CI, 0.131 to 0.996; p=0.049) and lower third location (HR, 0.624; 95% CI, 0.413 to 0.943; p=0.025) were inversely correlated with overall survival. During median follow-up period of 72 months, overall survival rate was not significantly different between the EBV and HP coinfection group and others (97.6% vs 86.8%, log-rank p=0.144). In non-GCLS patients (n=920), overall survival rate was not significantly different between the EBV infection group and others (96.9% vs 86.4%, log-rank p=0.126). Conclusions EBV and HP coinfection is not an independent prognostic factor for gastric cancer. EBV infection status, regardless of HP infection, affects the clinicopathologic features of all types of gastric cancer. However, it does not lead to a significant difference in overall survival of non-GCLS patients.

Prognostic Implication of EBV Infection in Gastric Carcinomas: A Systematic Review and Meta-Analysis

“…The estimated EBV positivity rate in the present study was 10.4%. In the eligible studies, the EBV positivity rates ranged from 2.0% to 40.1% [ 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , ...…”

“…The differences in tumor subtype and molecular composition can affect tumor behaviors [ 4 , 5 , 6 , 7 , 8 ]. The EBV positivity rate in GCs can vary depending on various factors, such as region [ 2 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 ,…”

Comment on “Infectious pathogens and risk of esophageal, gastric and duodenal cancers and ulcers in China: A case‐cohort study”

“…3 EBV infection status, regardless of the status of Helicobacter pylori co-infection, influences the clinicopathologic features of all types of gastric cancer. 4 These findings indicate that gastric carcinogenesis by EBV differs from the inflammatory mechanism of Helicobacter pylori infection. Hirabayashi et al recommended that primary prevention through a potentially effective vaccine against EBV might prevent estimated 81,000 incident EBVaGCs worldwide annually.…”

Clinical Relevance of Helicobacter pylori Coinfection in Ebstein-Barr Virus-Associated Gastric Carcinoma

“…According to the present study, HP coinfection did not seem to determine the clinicopathologic characteristics in EBVaGC, since EBV+/HP+ GC followed the same features as EBVaGC. In Supplementary Table 1, 9 the clinicopathologic features of the EBV+/HP+ group were not different from EBV+/HP– group, while demonstrating a significant distinction between EBV+/HP+ and EBV– patients. This suggests that EBV regardless of HP infection is a key factor for determining the clinical phenotype in GC.…”

“…In this issue of Gut and Liver , Noh et al 9 retrospectively enrolled 956 patients who had undergone surgery for GC between September 2014 and August 2015, and they aimed to investigate the effect of EBV and HP coinfection on the clinicopathologic features and prognosis in GC, as well as to evaluate the role of EBV infection in non-GCLS. In results, EBV and HP coinfection was significantly associated with male sex, proximal location, GCLS morphology, and equivocal p53 expression, although it did not show differences in overall survival (OS).…”