{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T13:50:07Z","timestamp":1788875407536,"version":"build-2803163510"},"reference-count":18,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Digestive Endoscopy"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Epstein\u2013Barr virus\u2010associated gastric cancer (EBVGC) has been reported to be associated with a low risk for lymph node metastasis (LNM). However, the curative criteria for endoscopic submucosal dissection (ESD) for submucosal EBVGC (pT1b\u2010EBVGC) remain unclear. Our study aimed to investigate the risk factors for LNM in pT1b\u2010EBVGC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective multicenter study at five institutes in Japan. We reviewed medical records and extracted all pT1b\u2010EBVGC cases that met the following criteria: (i) histologically proven submucosal gastric cancer; (ii) surgical or endoscopic resection between January 2000 and December 2016; and (iii) presence of Epstein\u2013Barr virus (EBV) in tumor cells verified by EBV\u2010encoded small RNA <jats:italic>in situ<\/jats:italic> hybridization (EBER\u2010ISH). The association between clinicopathological factors and LNM were assessed using multivariable logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 185 pT1b\u2010EBVGC cases were included in the analysis. LNM was found in nine cases (4.9%). Multivariable logistic regression analysis demonstrated that lymphatic invasion (OR 9.1; 95% CI 2.1\u201346.1) and submucosal invasion \u22654000\u00a0\u03bcm (OR 9.2; 95% CI 1.3\u2013110.3) were significant risk factors for LNM. When we focused on pT1b\u2010EBVGC without lymphatic invasion and with submucosal invasion &lt;2000\u00a0\u03bcm, the rate of LNM was 0% (0\/96, 95% CI 0\u20133.8%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings indicated that lymphatic invasion and submucosal invasion \u22654000\u00a0\u03bcm were significant risk factors for LNM. ESD could be an appropriate option for pT1b\u2010EBVGC without lymphatic invasion and with submucosal invasion &lt;2000\u00a0\u03bcm.<\/jats:p><\/jats:sec>","DOI":"10.1111\/den.13823","type":"journal-article","created":{"date-parts":[[2020,8,27]],"date-time":"2020-08-27T17:37:45Z","timestamp":1598549865000},"page":"592-597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Risk for lymph node metastasis in Epstein\u2013Barr virus\u2010associated gastric carcinoma with submucosal invasion"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9537-4993","authenticated-orcid":false,"given":"Yosuke","family":"Tsuji","sequence":"first","affiliation":[{"name":"Departments of Department of Gastroenterology Graduate School of Medicine, The University of Tokyo Tokyo 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