John G Aversa1,2, Minkyo Song3, Nan Hu4, Alisa M Goldstein5, Stephen M Hewitt6, Margaret L Gulley7, Sanford Dawsey8, Maria Constanza Camargo9, Philip R Taylor10, Charles S Rabkin11. 1. Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. aversaj@gmail.com. 2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Room 6E582, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. aversaj@gmail.com. 3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E204, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 4. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 7E236, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 5. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E438, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 6. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, 10/3N252, Bethesda, MD, 20892, USA. 7. Laboratory Medicine, Department of Pathology, University of North Carolina, 160 Medical Drive, 913 Brinkhous-Bullitt Building, Chapel Hill, NC, 27599, USA. 8. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E302, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 9. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E338, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 10. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E320, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA. 11. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E110, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA.
Abstract
BACKGROUND: Epstein-Barr virus (EBV) positivity is associated with better gastric cancer prognosis and is found in a relatively fixed 9% of tumors worldwide. AIM: We aimed to examine the EBV status of gastric adenocarcinomas in a very high-incidence population and to compare prevalence between cardia and non-cardia anatomic subsites. METHODS: We evaluated 1035 adult gastric adenocarcinoma cases presenting during 1997-2005 to the Shanxi Cancer Hospital in Taiyuan, Shanxi Province, China. EBV-encoded RNA was detected in alcohol-fixed paraffin-embedded tumor specimens by in situ hybridization. Associations were assessed in case-case comparisons using the Chi-squared test for categorical variables and the Mann-Whitney U test for continuous variables, with p values < 0.05 considered statistically significant. Adjusted odds ratios were calculated using logistic regression, and mortality hazard ratios (HRs) were estimated by Cox proportional hazards regression. RESULTS: Sixty-four percent of the evaluated cancers were found in the cardia. Cardia tumor localization was associated with male sex, advanced primary tumor stage, better differentiated histology, and intestinal-type Lauren classification. Four percent of the non-cardia and only 0.9% of cardia cancers were EBV-positive. EBV positivity was associated with better overall survival (adjusted HR 0.30, 95% CI 0.14-0.63). CONCLUSIONS: Our study highlights unusually low EBV prevalence in gastric adenocarcinoma among a high-incidence population, particularly for cardia cancers. These findings suggest a unique risk factor profile for the high incidence of gastric cancer in this population.
BACKGROUND: Epstein-Barr virus (EBV) positivity is associated with better gastric cancer prognosis and is found in a relatively fixed 9% of tumors worldwide. AIM: We aimed to examine the EBV status of gastric adenocarcinomas in a very high-incidence population and to compare prevalence between cardia and non-cardia anatomic subsites. METHODS: We evaluated 1035 adult gastric adenocarcinoma cases presenting during 1997-2005 to the Shanxi Cancer Hospital in Taiyuan, Shanxi Province, China. EBV-encoded RNA was detected in alcohol-fixed paraffin-embedded tumor specimens by in situ hybridization. Associations were assessed in case-case comparisons using the Chi-squared test for categorical variables and the Mann-Whitney U test for continuous variables, with p values < 0.05 considered statistically significant. Adjusted odds ratios were calculated using logistic regression, and mortality hazard ratios (HRs) were estimated by Cox proportional hazards regression. RESULTS: Sixty-four percent of the evaluated cancers were found in the cardia. Cardia tumor localization was associated with male sex, advanced primary tumor stage, better differentiated histology, and intestinal-type Lauren classification. Four percent of the non-cardia and only 0.9% of cardia cancers were EBV-positive. EBV positivity was associated with better overall survival (adjusted HR 0.30, 95% CI 0.14-0.63). CONCLUSIONS: Our study highlights unusually low EBV prevalence in gastric adenocarcinoma among a high-incidence population, particularly for cardia cancers. These findings suggest a unique risk factor profile for the high incidence of gastric cancer in this population.
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