# Demographic/clinicopathological characteristics and prognosis of resectable Epstein-Barr virus-associated gastric cancer: a nested case-control study from an Eastern China

## TL;DR

This study examines the characteristics and outcomes of a specific type of stomach cancer linked to the Epstein-Barr virus in patients from Eastern China.

## Contribution

The study provides new insights into the clinicopathological features and prognosis of resectable EBV-associated gastric cancer through a nested case-control design.

## Key findings

- EBVaGC patients were predominantly male and had more undifferentiated tumors.
- Elevated CEA levels and pTNM stage III were independent risk factors for survival outcomes in EBVaGC patients.
- EBVaGC showed a trend toward better disease-free survival compared to EBV-negative gastric cancer, though not statistically significant.

## Abstract

Epstein-Barr virus-associated gastric cancer (EBVaGC) represents a distinct molecular subtype of gastric cancer (GC). This multicenter study aimed to investigate the clinicopathological characteristics and prognosis of resectable EBVaGC patients.

Data were prospectively collected and retrospectively analyzed from 1,400 patients at Ningbo No. 2 Hospital from January 2014 to December 2023 and 55 EBVaGC patients were identified. Additionally, 95 EBVaGC patients from two external cooperative centers were included. A 1:4 propensity score matching (PSM) analysis was performed between EBVaGC patients and EBV-negative gastric cancer (EBVnGC) patients. Median follow-up duration was 34 months.

Among the 150 EBVaGC patients, the median age was 64, and 88.7% were male. Undifferentiated tumors were more common. During the follow-up, 121 EBVaGC patients did not experience recurrence. After PSM, there were 137 EBVaGC patients and 548 EBVnGC patients. In EBVaGC patients, elevated Carcinoembryonic Antigen (CEA) levels (HR = 8.11, p=0.025) and pathological tumor-node-metastasis (pTNM) stage III (HR = 19.57, p=0.008) were independent risk factors for overall survival (OS). For disease-free survival (DFS), elevated CEA levels (HR = 6.23, p=0.035) and pTNM stage III (HR = 18.51, p=0.007) were independent risk factors. There was no significant difference in OS between the two groups (p=0.204). Compared to EBVnGC patients, EBVaGC patients showed a trend towards better DFS, although this did not reach statistical significance(p=0.061).

EBVaGC patients exhibit unique clinicopathological characteristics and may show a trend toward better prognosis compared with EBVnGC patients, although this difference did not reach statistical significance.