Very Low Risk of Lymph Node Metastasis in Epstein-Barr Virus-associated Early Gastric Carcinoma With Lymphoid Stroma

Epstein-Barr virus-associated early gastric carcinoma with lymphoid stroma (EBV-GCLS) is a rare variant of early gastric carcinomas. Clinicopathological features of this variant remain obscure, especially in Chinese patients. By a retrospective review of 595 consecutive radical gastrectomies for early gastric carcinoma from 2006 to 2018, we identified 8 (1.3%, 8/595) EBV-GCLS cases. Clinicopathologic characteristics were compared between EBV-GCLSs and 109 conventional early gastric carcinomas, which were divided into 3 subgroups, according to the invasion depth. All 8 EBV-GCLSs occurred in male patients and invaded deep submucosa (SM2) without lymph node metastasis (LNM), four (50%) of which had synchronous non-gastric malignant tumors (3 gastric gastrointestinal stromal tumors and 1 primary clear cell renal cell carcinoma), and four (50%) arose in the proximal stomach. Compared to conventional early gastric carcinomas, EBV-GCLS was more frequent with SM2 invasion, poor differentiation, and synchronous non-gastric carcinoma tumor, but not in age, gender, macroscopic type, location, size, perineural invasion, lymphovascular invasion, and pathologic stage. In invasion-depth stratified comparisons with the SM2 subgroup, the frequency of LNM in EBV-GCLS was significantly lower than that of conventional early gastric carcinomas ( p < 0.05) and the 5-year survival rate of patients with EBV-GCLS was better than that of conventional early gastric carcinomas in 3 subgroups (100% vs 91.5%, 85.7%, 83.9%, respectively), although the differences did not reach a statistically significant level due to the small sample size. In conclusion, Even with poor differentiation and SM2 invasion, EBV-GCLS showed very low risk of LNM and may be a candidate for endoscopic therapy.