2025 年第 1 期 第 0 卷

Epstein-Barr病毒相关性早期胃癌的综合特征分析

Comprehensive characteristics of Epstein-Barr virus-associated early gastric cancer

作者：杨霖健1 赵梅莘2 张静1 丁士刚1

英文作者：Yang Linjian1， Zhao Meixin2， Zhang Jing1 Ding Shigang1

单位：1北京大学第三医院消化科，北京100191；2北京大学第三医院核医学科，北京100191

英文单位：1Department of Gastroenterology Peking University Third Hospital Beijing 100191 China; 2Department of Nuclear Medicine Peking University Third Hospital Beijing 100191 China

关键词：早期胃癌；  Epstein-Barr病毒；  临床病理特征；  内镜特征

英文关键词：Earlygastriccancer；  Epstein-Barrvirus；  Clinicopathologicalcharacteristics;  Endoscopiccharacteristics

• 摘要：

• 目的  分析Epstein-Barr病毒相关性早期胃癌（EBVaEGC）的临床、内镜及病理特征，探究与EBVaEGC相关的危险因素。方法  回顾性收集2010年1月至2022年12月于北京大学第三医院行内镜黏膜下剥离术或外科手术治疗的247例早期胃癌患者。依据术后病理组织EBV编码小RNA原位杂交结果，分为EBVaEGC组与EBV阴性早期胃癌（EBVnEGC）组。比较2组临床、内镜及病理特征，采取单因素及多因素Logistic回归方法分析相关特征与EBVaEGC的相关性。结果  共检出EBVaEGC患者25例，EBVnEGC患者222例。EBVaEGC组腹痛、白蛋白＞40 g/L比例均低于EBVnEGC组，单核细胞计数、单核细胞计数＞0.33×109/L比例均高于EBVnEGC组（均P＜0.05）。病理特征方面，EBVaEGC组肿瘤最大直径短于EBVnEGC组，肿瘤最大直径≥1.5 cm、背景黏膜肠上皮化生比例均低于EBVnEGC组，背景黏膜为淋巴细胞大量浸润或淋巴滤泡形成比例高于EBVnEGC组（均P＜0.05）。多因素Logistic回归分析结果显示白蛋白水平≤40 g/L（比值比=3.367，95%置信区间：1.080~10.504，P=0.037）、肿瘤最大直径＜1.5 cm（比值比=4.582，95%置信区间：1.433~14.646，P=0.010）、背景黏膜无肠上皮化生（比值比=6.032,95%置信区间：1.539~23.643，P=0.010）、淋巴细胞大量浸润或淋巴滤泡形成（比值比=3.929,95%置信区间：1.247~12.380，P=0.019）为EBVaEGC的独立危险因素。结论  EBVaEGC具有不同的临床病理特征，术前白蛋白水平偏低、肿瘤直径较小、背景黏膜无明显肠上皮化生且肿瘤区域及周边合并淋巴细胞大量浸润或淋巴滤泡形成的患者需考虑为EBVaEGC可能，应进行原位杂交检测以明确诊断。

• Objective  To analyze the clinical, endoscopic and pathological characteristics of Epstein-Barr virus (EBV)-associated early gastric cancer （EBVaEGC） and explore the risk factors associated with EBVaEGC. Methods   Totally 247 patients diagnosed with early gastric cancer who underwent surgery or endoscopic submucosal dissection in Peking University Third Hospital from January 2010 to December 2022 were retrospectively enrolled. Patients were divided into EBVaEGC group and EBV-negative early gastric cancer (EBVnEGC) group according to the results of EBV-encoded small RNA in situ hybridization. The clinical, endoscopic and pathological characteristics of the two groups were compared. Univariate and multivariate Logistic regression analyses method were performed to assess the correlations between related characteristics and EBVaEGC. Results   There were 25 cases of EBVaEGC and 222 cases of EBVnEGC. The proportions of abdominal pain and albumin >40 g/L in the EBVaEGC group were lower than those in the EBVnEGC group, and the proportions of monocyte count and monocyte count >0.33×109/L were higher than those in the EBVnEGC group (all P<0.05). In terms of pathological features, the maximum tumor diameter in the EBVaEGC group was shorter than that in the EBVnEGC group, the maximum tumor diameter ≥1.5 cm and the proportion of background mucosal intestinalization were lower than those in the EBVnEGC group, and the proportion of lymphocyte infiltration or lymphoid follicle formation in the background mucosa was higher than that in the EBVnEGC group (all P<0.05). Multivariate Logistic regression analysis indicated that albumin ≤40 g/L ［odds ratio (OR)=3.367, 95% confidence interval (CI):1.080-10.504, P=0.037］, tumor maximum diameter <1.5 cm （OR=4.582, 95%CI:1.433-14.646, P=0.010）, without intestinal metaplasia in the background mucosa （OR=6.032, 95%CI:1.539-23.643, P=0.010）, and the presence of massive lymphocyte infiltration or lymphoid follicle formation （OR=3.929, 95%CI:1.247-12.380, P=0.019） were independent risk factors for EBVaEGC. Conclusions   EBVaEGC exhibits distinct clinicopathological features. Patients with a relatively low preoperative albumin level, small tumor diameter, absence of obvious intestinal metaplasia in the background mucosa, and the presence of massive lymphocyte infiltration or lymphoid follicle formation may be indicative of EBVaEGC, and in situ hybridization should be performed to confirm the diagnosis of EBVaEGC.