[Clinicopathological characteristics and prognosis of alpha-fetoprotein producing gastric cancer]

Elevated Serum Alpha-Fetoprotein Is a Significant Prognostic Factor for Patients with Gastric Cancer: Results Based on a Large-Scale Retrospective Study

Objectives

The aim of this work is to study the clinicopathological features and prognostic factors of serum alpha-fetoprotein (AFP)–positive gastric cancer (GC).

Methods

A cohort study including 2,318 patients with GC who underwent radical surgery from January 2008 to December 2015 was retrospectively analyzed. Patients were divided into two groups according to preoperative serum AFP values: 191 patients with AFP-positive GC (AFP > 20 ng/ml, 8.24%) and 2,127 patients with AFP-negative GC (AFP ≤ 20 ng/ml, 91.76%). The clinicopathological features and prognostic factors were explored.

Results

Compared with AFP-negative GC, AFP-positive GC had higher rates of liver metastasis, lymph node metastasis, venous invasion, and nerve invasion (all P < 0.05). The 5-year OS, DFS, and mLMFS of AFP-positive GC were shorter than AFP-negative GC (55.00% vs. 45.04%, P < 0.001; 39.79% vs. 34.03%, P < 0.001; 13.80 months vs. 16.25 months, P = 0.002). In whole cohort, multivariate analysis found that serum AFP levels (positive vs. negative), pT stage, pN stage, nerve invasion (yes or no), and venous invasion (yes or no) were independent prognostic factors. Serum AFP levels (20–300 ng/ml vs. 300–1,000 ng/ml vs. >1,000 ng/ml), pT stage, pN stage, and venous invasion (yes or no) were independent prognostic factors in AFP-positive GC.

Conclusion

Liver metastases and venous invasion are more likely to occur in AFP-positive GC and lead to poor prognosis. Serum AFP level is an independent prognostic factor in patients with GC. As the level of AFP increases, the prognosis becomes worse.

A 50-Year-Old Man with Fulminant Alpha-Fetoprotein-Producing Gastric Carcinoma and Disseminated Intravascular Coagulation

Patient: Male, 50-year-old

Final Diagnosis: Disseminated intravascular coagulatio • gastric cancer

Symptoms: Paralysis

Medication: —

Clinical Procedure: —

Specialty: Oncology

Prognostic value of serum alpha-fetoprotein levels in patients with gastric cancer: a meta-analysis

Background

Methods

Results

Conclusions

Successful multimodal therapy for an α-fetoprotein-producing gastric cancer patient with simultaneous liver metastases

α-fetoprotein-producing gastric cancer (AFPGC) is considered to be a special type of stomach cancer, due its features of high malignancy, fast progression, easy transferral and a poor prognosis. No standard therapy is currently available for patients with AFPGC. In the present study, the case of a 59-year-old male diagnosed with AFPGC and simultaneous liver metastases is presented. The patient presented with abdominal bloating and multiple liver lesions were revealed upon imaging. During the course of treatment, the patient's serum AFP level increased to a maximum of 20,624.6 µg/l. The patient survived for 30 months and was ultimately treated with multimodal therapy, including surgery, chemotherapy, interventional therapy and molecular targeted therapy. Treatment with paclitaxel, irinotecan and TS-1, particularly sorafenib as a molecular targeted drug, are effective for such patients. The choice of chemotherapy regimen according to the Lauren classification and the use of oral sorafenib are likely to be novel and effective treatments for this type of stomach cancer. However, investigations should be performed to identify the gastric cancer patient population most receptive to sorafenib treatment. In addition, combined chemotherapy and molecular targeting treatment requires further study in order to determine if a synergistic effect is present. Further investigation in a large-sample study is required to confirm the validity of these results.