Gut Liver.  2023 Jan;17(1):69-77. 10.5009/gnl210593.

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

• Noh JH
• Shin JY
• Lee JH
• Park YS
• Lee IS
• Kim GH
• Na HK
• Ahn JY
• Jung KW
• Kim DH
• Choi KD
• Song HJ
• Lee GH
• Jung HY

• KMID: 2538158
• DOI: http://doi.org/10.5009/gnl210593

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 nonGCLS patients.

Keyword

Coinfection; Gastric cancer; Gastric carcinoma with lymphoid stroma; Prognosis