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Low Epstein–Barr Virus Prevalence in Cardia Gastric Cancer Among a High-Incidence Chinese Population

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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.

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Acknowledgments

The authors would like to acknowledge the assistance of staff members of the Shanxi Cancer Hospital.

Funding

This study was funded by the Intramural Research Program of the Division of Cancer Epidemiology and Genetics, United States National Cancer Institute.

Author information

Authors and Affiliations

  1. Surgical Oncology Program, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA

    John G. Aversa

  2. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E204, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Minkyo Song

  3. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 7E236, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Nan Hu

  4. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E438, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Alisa M. Goldstein

  5. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E302, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Sanford Dawsey

  6. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E338, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Maria Constanza Camargo

  7. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E320, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Philip R. Taylor

  8. Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Room 6E110, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    Charles S. Rabkin

  9. Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, 10 Center Drive, 10/3N252, Bethesda, MD, 20892, USA

    Stephen M. Hewitt

  10. Laboratory Medicine, Department of Pathology, University of North Carolina, 160 Medical Drive, 913 Brinkhous-Bullitt Building, Chapel Hill, NC, 27599, USA

    Margaret L. Gulley

  11. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Room 6E582, 9609 Medical Center Drive, Rockville, MD, 20892-9776, USA

    John G. Aversa

Authors
  1. John G. Aversa
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  2. Minkyo Song
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  3. Nan Hu
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  4. Alisa M. Goldstein
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  5. Stephen M. Hewitt
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  6. Margaret L. Gulley
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  7. Sanford Dawsey
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  8. Maria Constanza Camargo
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  9. Philip R. Taylor
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  10. Charles S. Rabkin
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by John G. Aversa, Minkyo Song, Stephen M. Hewitt, Margaret L. Gulley, Sanford Dawsey, Phillip R. Taylor, and Charles S. Rabkin. The first draft of the manuscript was written by John G. Aversa, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to John G. Aversa.

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Conflict of interest

The authors declare that they have no personal or financial conflict of interest.

Ethical approval

All procedures performed were in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The study was approved by the institutional review boards of the Shanxi Cancer Hospital, the National Cancer Institute, and the University of North Carolina.

Informed consent

Informed consent to be included in the study was obtained from all individual participants included in the study.

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Aversa, J.G., Song, M., Hu, N. et al. Low Epstein–Barr Virus Prevalence in Cardia Gastric Cancer Among a High-Incidence Chinese Population. Dig Dis Sci 66, 1220–1226 (2021). https://doi.org/10.1007/s10620-020-06288-1

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  • DOI: https://doi.org/10.1007/s10620-020-06288-1

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