Long-term survival analysis after radical gastrectomy for Epstein-Barr virus-associated gastric cancer: A multicenter study

Abstract

Background

The prognosis of Epstein-Barr virus-associated gastric cancer (EBVaGC)needs to be validated by high-quality studies. This study aimed to assess the long-term survival of EBVaGC patients after radical gastrectomy using multicenter data to explore the potential value of EBV infection status as a prognostic predictor.

Methods

We analyzed the clinical data of patients with EBVaGC and Epstein-Barr virus-negative gastric cancer (EBVnGC) who underwent radical gastrectomy from January 2013 to July 2020. The Kaplan-Meier method and Cox regression analysis were used to evaluate overall survival (OS) and disease-free survival (DFS). A Random Survival Forest (RSF) model was constructed to predict the prognosis.

Results

After propensity score matching, 205 and 410 patients were included in the EBVaGC and EBVnGC groups, respectively. The 3-year OS and DFS rates in the EBVaGC group were significantly higher than those in the EBVnGC group. Multivariate analysis indicated that EBER(Epstein-Barr virus-encoded small RNA) positivity was an independent protective factor for OS and DFS. Among stage II and III EBVaGC patients, those receiving ≥4 cycles of chemotherapy had a 3-year OS significantly better than those receiving <4 cycles. The RSF model based on EBER status outperformed the Cox model and TNM staging system in predicting the 3-year OS and DFS.

Conclusion

The prognostic prediction model established based on the EBER status has good clinical application value and can provide a new reference for clinical follow-up management. It is recommended that patients with stage II and III EBVaGC receive at least four cycles of chemotherapy postoperatively to improve survival.