Common variable immunodeficiency: an important but little-known risk factor for gastric cancer

ABSTRACT Introduction: although it is a rare disease, common variable immunodeficiency (CVID) stands out as the most frequent primary symptomatic immunodeficiency. Carriers are prone to a variety of recurrent bacterial infections, in addition to the risk of developing autoimmune diseases and neoplasms including gastric cancer (GC). Despite the recognized risk, there are no specific standardized protocols for the management of GC in these patients, so the reported oncological results are varied. Thus, this study aims to describe the clinicopathological characteristics and prognosis of patients with CVID undergoing surgical treatment of GC. Methods: all patients with GC undergoing surgical treatment between 2009 and 2020 were retrospectively evaluated. Later, patients diagnosed with CVID were identified and this group was compared with the remaining patients without any immunodeficiency. Results: among the 1101 patients with GC evaluated in the period, 10 had some type of immunodeficiency, and 5 were diagnosed with CVID. Patients with CVID had younger age, lower BMI, and smaller lesions compared to those without CVID. Four patients underwent curative gastrectomy and one patient underwent jejunostomy. Two patients died (1 palliative and 1 curative) and one patient had disease recurrence. There was no statistically significant difference regarding the incidence of postoperative complications and survival between the evaluated groups. Conclusion: the CVID incidence in patients with GC undergoing surgical treatment was 0.5%, occurring at a less advanced age, but with no difference regarding surgical and oncological results.

摘要
引言：普通变异型免疫缺陷病（common variable immunodeficiency, CVID）虽为罕见病，却是最常见的原发性有症状性免疫缺陷病。该类患者易罹患多种复发性细菌感染，同时还面临自身免疫性疾病及包括胃癌（gastric cancer, GC）在内的肿瘤性疾病的发病风险。尽管此类人群的胃癌发病风险已得到公认，但目前尚无针对该类患者胃癌管理的特异性标准化方案，因此已报道的肿瘤学结局存在较大差异。为此，本研究旨在探讨接受外科手术治疗的CVID合并胃癌患者的临床病理特征与预后情况。
方法：本研究对2009年至2020年间接受外科手术治疗的胃癌患者进行回顾性评估。随后筛选出确诊为CVID的患者，并将该组患者与其余无任何免疫缺陷的胃癌患者进行对照比较。
结果：本研究纳入的1101例胃癌患者中，10例合并各类免疫缺陷，其中5例确诊为CVID。与非CVID的胃癌患者相比，CVID合并胃癌患者的发病年龄更轻、体质量指数（BMI）更低、病灶体积更小。5例CVID患者中，4例接受了根治性胃切除术，1例接受了空肠造口术。2例患者死亡（1例为姑息治疗术后死亡，1例为根治性手术后死亡），1例出现肿瘤复发。两组患者的术后并发症发生率及生存率差异均无统计学意义。
结论：接受外科手术治疗的胃癌患者中，CVID的合并率为0.5%，此类患者发病年龄更小，但手术治疗结局及肿瘤学结局与非CVID患者无显著差异。