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Du H, Yang Q, Ge A, Zhao C, Ma Y, Wang S. Explainable machine learning models for early gastric cancer diagnosis. Sci Rep 2024; 14:17457. [PMID: 39075116 PMCID: PMC11286780 DOI: 10.1038/s41598-024-67892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 07/17/2024] [Indexed: 07/31/2024] Open
Abstract
Gastric cancer remains a significant global health concern, with a notably high incidence in East Asia. This paper explores the potential of explainable machine learning models in enhancing the early diagnosis of gastric cancer. Through comprehensive evaluations, various machine learning models, including WeightedEnsemble, CatBoost, and RandomForest, demonstrated high potential in accurately diagnosing early gastric cancer. The study emphasizes the importance of model explainability in medical diagnostics, showing how transparent, explainable models can increase trust and clinical acceptance, thereby improving diagnostic accuracy and patient outcomes. This research not only highlights key biomarkers and clinical features critical for early detection but also presents a versatile approach that could be applied to other medical diagnostics, promoting broader adoption of machine learning in clinical settings.
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Affiliation(s)
- Hongyang Du
- Heze Administrative Approval Guarantee Center, 3443 Huanghe East Road, Heze City, 274000, Shandong Province, China
| | - Qingfen Yang
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Aimin Ge
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Chenhao Zhao
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Yunhua Ma
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China
| | - Shuyu Wang
- Heze Municipal Hospital, 2888 Caozhou West Road, Heze City, 274031, Shandong Province, China.
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Guo J, Zheng L, Chen J, Lin W. Disparities of tumour markers in intraperitoneal drainage fluid between laparoscopic and open radical gastrectomy for gastric cancer. Wideochir Inne Tech Maloinwazyjne 2024; 19:233-242. [PMID: 38973797 PMCID: PMC11223551 DOI: 10.5114/wiitm.2024.139509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/22/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Despite the remarkable progress in minimally invasive surgery, the potential association between laparoscopic gastrectomy and the risk of peritoneal metastasis remains uncertain. Aim To investigate variations in tumour markers in intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer. Material and methods A total of 106 patients diagnosed with gastric cancer between July 2018 and November 2020 were included in this study, 45 of whom underwent laparoscopic radical gastrectomy (laparoscopic group) and 61 underwent open radical gastrectomy (open group). Variations in the levels of carcinoembryonic antigen (CEA), cancer antigen 125 (CA125), cancer antigen 199 (CA199), and α-fetoprotein (AFP) in the intraperitoneal drainage fluid were compared and analysed on postoperative days (PODs) 1, 2, 3, and 5 between the two groups. Additionally, the postoperative 3-year survival rates between the two groups were compared and analysed. Results No significant differences in CEA, CA199, and AFP levels in the intraperitoneal drainage fluid were observed between the two groups on postoperative days (PODs) 1, 2, 3, and 5 (p > 0.05). However, the level of CA125 in the intraperitoneal drainage fluid of the laparoscopic group was notably higher than that of the open group on POD 2 (p < 0.05); however, there were no significant differences between the two groups on PODs 1, 3, and 5 (p > 0.05). There was no significant difference in the 3-year postoperative survival rates between the two groups. Conclusions There were no significant differences in CEA, CA125, CA199, and AFP levels in the intraperitoneal drainage fluid between laparoscopic radical gastrectomy and open radical gastrectomy for gastric cancer, confirming from another perspective that laparoscopic radical gastrectomy does not increase the risk of intraperitoneal metastasis.
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Affiliation(s)
- Jian Guo
- Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, The Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Longzhi Zheng
- Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, The Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Junwei Chen
- Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, The Affiliated Hospital of Putian University, Putian, Fujian, China
| | - Wei Lin
- Department of Gastrointestinal Surgery and Gastrointestinal Surgery Research Institute, The Affiliated Hospital of Putian University, Putian, Fujian, China
- The School of Clinical Medicine, Fujian Medical University, University Town, Fuzhou, Fujian, China
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Li Y, Lin Y, Zhao L, Yang C, Wang B, Gao Z, Ye Y, Wang S, Shen Z. Characteristics of alpha-fetoprotein-positive gastric cancer revealed by analysis of cancer databases and transcriptome sequencing data. Transl Oncol 2023; 36:101737. [PMID: 37478671 PMCID: PMC10375854 DOI: 10.1016/j.tranon.2023.101737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/08/2023] [Accepted: 07/10/2023] [Indexed: 07/23/2023] Open
Abstract
Gastric cancer is one of the most common malignant tumors in the world. Alpha fetoprotein (AFP)-positive gastric cancer (AFPP-GC) is considered a special entity among gastric cancers. There is still controversy regarding the clinicopathological characteristics and prognosis of AFPP-GC, and the potential mechanism underlying its high malignant potential is still unclear. A comprehensive description of AFPP-GC genomic characteristics and regulatory mechanisms is lacking. This study analyzed the pathological characteristics and prognosis of AFPP-GC by utilizing clinical samples. The results showed that AFPP-GC has a poor prognosis and a high of risk liver metastasis. Tissue transcriptome sequencing showed that genes with high expression in AFPP-GC were involved in the activation of various cancer pathways, and genes with low expression were involved in the immune response. Single-sample gene set enrichment analysis showed that overexpression of AFP in AFPP-GC significantly inhibited the infiltration of CD8+ T cells. To further explore the genomic characteristics of AFPP-GC, the signaling pathway by which AFP regulates the invasion and metastasis of AFPP-GC cells was discussed. The results showed that AFPP-GC may promote cell invasion by regulating the PTEN/AKT1/SOX5/CES1 signaling axis. This study reveals the molecular mechanism underlying the increased malignant potential of AFPP-GC vs. AFP-negative gastric cancer (AFPN-GC). This provides important information for individualized treatment of AFPP-GC.
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Affiliation(s)
- Yansen Li
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China; Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yilin Lin
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Long Zhao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Changjiang Yang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Bo Wang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Zhidong Gao
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Yingjiang Ye
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Shan Wang
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China
| | - Zhanlong Shen
- Department of Gastroenterological Surgery, Peking University People's Hospital, Beijing, China.; Laboratory of Surgical Oncology, Beijing Key Laboratory of Colorectal Cancer Diagnosis and Treatment Research, Peking University People's Hospital, Beijing, China.
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Ota T, Sakashita K, Sawada R, Seki K, Maeda H, Tanaka N, Tsujinaka T. Long-term survival with nivolumab followed by irinotecan after total gastrectomy in alpha-fetoprotein-producing gastric cancer: a case report and review of the literature. Surg Case Rep 2023; 9:71. [PMID: 37150760 PMCID: PMC10164665 DOI: 10.1186/s40792-023-01653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare type of aggressive gastric cancer (GC) with a dismal prognosis. We present a patient with AFPGC who achieved long-term survival through a multidisciplinary approach. CASE PRESENTATION A 67-year-old man with advanced GC was referred to our hospital for systemic chemotherapy. He was diagnosed with cStage IVB AFPGC. During 2nd-line treatment, we could not control bleeding from the GC itself. After complete resection, during chemotherapy, portal venous tumor thrombi (PVTTs) and liver metastases were identified. With nivolumab followed by irinotecan, the PVTTs and liver metastases disappeared. Without immunotherapy and chemotherapy for 23 months, the patient has survived for 48 months so far with no recurrence of GC. CONCLUSION Long-term survival with AFPGC can be accomplished by using several different approaches, such as surgery, immunotherapy, and chemotherapy.
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Affiliation(s)
- Takayo Ota
- Department of Medical Oncology, Izumi City General Hospital, 4-5-1, Wake, Izumi, Osaka, 594-0073, Japan.
| | - Katsuya Sakashita
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Ryugo Sawada
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Kurumi Seki
- Department of Pathology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Hiroyuki Maeda
- Department of Radiology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Noriko Tanaka
- Department of Radiology, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
| | - Toshimasa Tsujinaka
- Department of Surgery, Izumi City General Hospital, Izumi, Osaka, 594-0073, Japan
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Akabane M, Yago A, Haruta S, Ohkura Y, Ueno M, Udagawa H. Re-evaluation of the prognosis of alpha-fetoprotein-producing gastric cancer from a single center: a case series study. Langenbecks Arch Surg 2023; 408:66. [PMID: 36695913 DOI: 10.1007/s00423-023-02817-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is reported to have biologically aggressive features and poor prognosis. A relatively large number of patients with AFPGC have achieved a long-term prognosis after surgery in our institution. This study aimed to clarify the clinical features of and re-evaluate the long-term outcomes of AFPGC. METHODS This analysis involved 465 patients who underwent surgery for gastric cancer (GC) at our institute between 1996 and 2020. The clinical features and long-term outcomes of the 24 patients with AFPGC were assessed. The differences in clinicopathological characteristics between AFPGC and non-AFPGC patients were statistically analyzed. RESULTS In patients with AFPGC, the median preoperative serum AFP level was 232 ng/mL. Tumor invasion of AFPGC was classified and clinical characteristics of AFPGC patients were as follows: nodal metastasis, simultaneous liver metastasis, with malignant cells in ascites, lymphatic, and venous involvement. Postoperative surveillance revealed adjuvant therapy in fourteen, recurrence in eight, and four patients died of GC. The 3- and 5-year overall survival (OS) rates were 85.2% and 75.7% in AFPGC patients and 79.6% and 77.7% in non-AFPGC patients, respectively. The log-rank test identified no significant difference in OS between AFPGC and non-AFPGC patients. Tumor depth, nodal, and venous involvement showed significant differences between AFPGC and non-AFPGC patients. CONCLUSIONS AFPGC has aggressive biological features, but long-term prognosis after surgery does not seem to be as poor as claimed in previous studies. Therefore, it may be important to detect and start treatment early when surgery is feasible.
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Affiliation(s)
- Miho Akabane
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
| | - Akikazu Yago
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Shusuke Haruta
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Yu Ohkura
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Masaki Ueno
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Harushi Udagawa
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
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Zhan Z, Chen B, Yu J, Zheng J, Zeng Y, Sun M, Peng L, Guo Z, Wang X. Elevated Serum Alpha-Fetoprotein Is a Significant Prognostic Factor for Patients with Gastric Cancer: Results Based on a Large-Scale Retrospective Study. Front Oncol 2022; 12:901061. [PMID: 35847953 PMCID: PMC9277009 DOI: 10.3389/fonc.2022.901061] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThe aim of this work is to study the clinicopathological features and prognostic factors of serum alpha-fetoprotein (AFP)–positive gastric cancer (GC).MethodsA 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.ResultsCompared 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.ConclusionLiver 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.
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Affiliation(s)
- Zhouwei Zhan
- Department of Medical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Bijuan Chen
- Department of Radiotherapy, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jiami Yu
- Department of Medical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Jingxian Zheng
- Department of Medical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yi Zeng
- Department of Gastrointestinal Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Mingyao Sun
- Department of Clinical Nutrition, Fujian Provincial Hospital, Fuzhou, China
| | - Li Peng
- Department of Diagnostic Radiology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Zengqing Guo
- Department of Medical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- *Correspondence: Zengqing Guo, ; Xiaojie Wang,
| | - Xiaojie Wang
- Department of Medical Oncology, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- *Correspondence: Zengqing Guo, ; Xiaojie Wang,
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Wang B, Xie Y, Zheng L, Zheng X, Gao J, Liu X, Yuan Y, Li Z, Lu N, Xue L. Both the serum AFP test and AFP/GPC3/SALL4 immunohistochemistry are beneficial for predicting the prognosis of gastric adenocarcinoma. BMC Gastroenterol 2021; 21:408. [PMID: 34706681 PMCID: PMC8555135 DOI: 10.1186/s12876-021-01986-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 10/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Both gastric adenocarcinoma with primitive enterocyte phenotype (GAPEP) (including hepatoid adenocarcinoma) and alpha-fetoprotein (AFP)-producing gastric adenocarcinoma have poor prognoses. However, the value of the serum AFP test and AFP/glypican-3 (GPC3)/spalt-like transcription factor 4 (SALL4) immunohistochemistry is still not clear, and these two methods have not yet been thoroughly compared. METHODS We collected 421 consecutive non-neoadjuvant surgically or endoscopically resected gastric adenocarcinoma patients with serum AFP results before surgery (group A). We divided these cases into serum AFP-high (sAFP-H) and serum AFP-normal (sAFP-N) by serum AFP levels, and into GAPEP (expressing AFP, GPC3, or SALL4) and non-GAPEP (nGAPEP) by AFP/GPC3/SALL4 immunohistochemistry results. We also collected 12 non-resected gastric adenocarcinoma patients with serum AFP ≥ 7 ng/mL before treatment (group B). We analyzed these patients' clinicopathological characteristics and prognoses. RESULTS Seventeen (4.04%) patients in group A were sAFP-H. These patients were younger and mainly had tubular adenocarcinoma with later pT (P = 0.014) and pN (P = 0.047) categories and more lymphovascular invasion (P < 0.001), perineural spread (P = 0.008), and metastases or recurrence (P < 0.001). For immunohistochemistry, 34 (8.08%) cases were GAPEP, and GAPEP cases also had later pT categories than nGAPEP cases (P = 0.001). Most group B patients with elevated serum AFP (especially > 1000 ng/mL) had simultaneous metastases, mainly liver metastases. Both the serological method and immunohistochemical method were useful for predicting prognosis (AUC sAFP = 0.625, AUC A/G/S-IHC = 0.723, z statistic = 1.726, P = 0.084). The serum AFP level (especially > 1000 ng/mL) is more specific (100%), and immunohistochemistry is more sensitive (50%). CONCLUSION Both the serum AFP level and immunohistochemical expression of AFP/GPC3/SALL4 can be used to indicate a poor prognosis for gastric adenocarcinoma.
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Affiliation(s)
- Bingzhi Wang
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yibin Xie
- Department of Abdominal Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Li Zheng
- Department of General Surgery, the First People's Hospital of Dongcheng District, Beijing, 100075, China
| | - Xiaohao Zheng
- Department of Abdominal Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jia Gao
- Department of Clinical Laboratory, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiuyun Liu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yanling Yuan
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Zhuo Li
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Ning Lu
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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Kafka M, Wöll E, Brunhuber T, Gruber L, Tulchiner G, Staudacher N, Horninger W, Pichler R. A presumed extragonadal germ cell tumor that turned out to be a gastric cancer-a case report. Transl Androl Urol 2021; 10:2528-2533. [PMID: 34295739 PMCID: PMC8261445 DOI: 10.21037/tau-21-150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/12/2021] [Indexed: 12/16/2022] Open
Abstract
A solely retroperitoneal mass in males in combination with elevated serum Alpha-Fetoprotein (AFP) and beta-human choriogonadotropin (β-HCG) levels is highly indicative of a metastatic testicular cancer. Although testicular cancers are rare, they represent the most common diagnosed cancer in males between 14 and 40 years. However, in cases without evidence of a primary testicular tumor, the rare diagnosis of a retroperitoneal extragonadal germ cell tumor (EGCT) must be assumed. Here, we describe the first published case of a 66-year-old man presenting with this typical clinical picture and the diagnosis of an AFP and β-HCG producing advanced gastric cancer with retroperitoneal lymph node metastases mimicking a primary retroperitoneal EGCT. The final diagnosis was only made by gastroscopy performed after a CT-guided retroperitoneal lymph node biopsy revealed an adenocarcinoma, suggesting an upper gastrointestinal tract primary origin. However, a specific initial anamnesis and also in the primary staging, including a full-body CT-scan there was no hint for another primary tumor. Only the slightly unusual extension of the retroperitoneal mass up to the ligamentum hepatoduodenale and the pylorus, as well as the atypical age made us question our initial diagnosis. This extraordinary case is of special clinical interest to all practising physicians and once again highlights the importance of keeping rare differential diagnosis such as AFP-producing gastrointestinal tumors in mind.
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Affiliation(s)
- Mona Kafka
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Thomas Brunhuber
- Laboratory of Pathology, Dr. Obrist and Dr. Brunhuber OG, Zams, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gennadi Tulchiner
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Nina Staudacher
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wolfgang Horninger
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
| | - Renate Pichler
- Department of Urology, Medical University of Innsbruck, Innsbruck, Austria
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Two cases of gastric adenocarcinoma with enteroblastic differentiation resected by endoscopic submucosal dissection. Clin J Gastroenterol 2021; 14:736-744. [PMID: 33629257 DOI: 10.1007/s12328-021-01356-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
Gastric adenocarcinoma with enteroblastic differentiation (GAED) is rare, highly malignant, and has higher vascular invasion and metastasis rates than conventional differentiated gastric cancer (CDGC). We report two cases of GAED that underwent curative resection by endoscopic submucosal dissection (ESD). Case 1 was an 82-year-old man with an elevated lesion in the gastric cardia. Biopsy revealed well-differentiated tubular adenocarcinoma. Pathological diagnosis of the ESD specimen revealed intramucosal gastric cancer without lymphovascular invasion (LVI). Although the surface layer of the lesion showed well and moderately differentiated tubular adenocarcinoma, clear cytoplasmic cancer cells positive for Sal-like protein-4 (SALL4) and Glypican-3 were found in a part of the deep layer. Therefore, GAED was diagnosed as present in a part of the whole lesion and covered with CDGC. Case 2 was an 83-year-old man with an elevated lesion in the gastric angulus. Biopsy revealed papillary and well-differentiated tubular adenocarcinomas. Pathological diagnosis of the ESD specimen revealed intramucosal gastric cancer without LVI. The entire lesion was occupied by papillary and tubular cancer cells, and had clear vesicles. Pure GAED was diagnosed, because the cells were SALL4 positive. In both cases, resection was curative despite the difference in pathological features.
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Xu X, Wang Q, Cao H, Gao Z, Qian G, Lu Q, Wu Y. Prognostic value of serum alpha-fetoprotein levels in patients with gastric cancer: a meta-analysis. J Int Med Res 2020; 48:300060519899780. [PMID: 32228092 PMCID: PMC7133086 DOI: 10.1177/0300060519899780] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Xiang Xu
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Qing Wang
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Huihua Cao
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Zhenyan Gao
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Guangyang Qian
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Qicheng Lu
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
| | - Yugang Wu
- Department of General Surgery, The Third Affiliated Hospital of Soochow University and The First People's Hospital of Changzhou, Changzhou, Jiangsu, China
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Clinical Evaluation of Serum Tumor Markers in the Diagnosis of Gastric Adenocarcinoma Staging and Grading. J Gastrointest Cancer 2020; 50:525-529. [PMID: 29806060 DOI: 10.1007/s12029-018-0091-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
ᅟ: Detection and quantitative measurements of diffused tumor markers in blood samples of patients with cancer is a facile and convenient method to determine prognosis and the appropriateness of the treatment. This study was done to evaluate the level of CA125, CEA, AFP, Beta HCG, and CA19-9 tumor markers and their relation to the stage and grade of the disease in patients with gastric adenocarcinoma. MATERIALS AND METHODS In a descriptive cross-sectional study, of 81 patients referred to the oncology department of Tohid Hospital, Sanandaj, Iran, in 1 year, with recently detected gastric adenocarcinoma, serum level of CEA, CA19-9, CA125, AFP, and Beta HCG tumor markers was measured by ELISA method before chemotherapy and surgery. Patients were divided into four groups based on stage of disease (I, II, III, IV), and in terms of tumor differentiation, degrees were classified in to three groups: low, high, and intermediate. To determine the correlation of tumor markers level with the stage and grade of the disease, the Kruskal-Wallis and Mann-Whitney U tests were used. RESULTS By progression, the stages of the disease, the serum level of CA19-9, CA125, and AFP tumor markers demonstrated a significant increase. But this difference between level of HCG and CEA was not significant with the staging. There was no significant difference between the serum level of tumor markers and the grading of disease in the patients. CONCLUSION Preoperative CA19-9, CA125, and AFP tumor markers measurements could be beneficial in detecting the progressed stages of the disease.
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Takahashi K, Nihei T, Aoki Y, Konno N, Nakagawa M, Munakata A, Okawara K, Ohtani H, Kashimura H. Rapidly progressed large cell neuroendocrine carcinoma of the stomach with an increased serum alpha fetoprotein level: a case report. Clin J Gastroenterol 2019; 13:225-232. [PMID: 31512156 DOI: 10.1007/s12328-019-01041-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 08/29/2019] [Indexed: 10/26/2022]
Abstract
An 82-year-old man who had multiple hepatic tumors, a gastric tumor, and ascites was referred to our hospital. On the time of our hospital visit, he had a high serum alpha fetoprotein (AFP) level of 1206 ng/mL. Upper gastrointestinal endoscopy revealed a Borrmann Type II gastric tumor approximately 40 mm in diameter in the lesser curvature of cardia, and forceps biopsy was performed. Endoscopic ultrasound fine-needle aspiration was also performed for hepatic tumor. The biopsy specimens from the gastric and hepatic tumor were diagnosed as large cell neuroendocrine carcinoma (LCNEC), containing AFP-positive cells only sporadically by immunohistochemistry. He was diagnosed with gastric LCNEC with liver metastasis. Retrospective analysis of endoscopic data obtained at 5 months ago revealed a 0-IIc lesion, approximately 10 mm in size, in the lesser curvature of cardia, the same area of the present gastric tumor. This indicated rapid growth rate of the present tumor. The patient developed jaundice 5 days after he visited our hospital. And he died 18 days after hospital admission.
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Affiliation(s)
- Koji Takahashi
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan.
| | - Takeshi Nihei
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Yohei Aoki
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Naoaki Konno
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Miyuki Nakagawa
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Akari Munakata
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Ken Okawara
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
| | - Haruo Ohtani
- Department of Pathology, Mito Saiseikai General Hospital, Ibaraki, Japan
| | - Hiroshi Kashimura
- Departments of Gastroenterology, Mito Saiseikai General Hospital, 3-3-10 Hutabadai, Mito-shi, Ibaraki, 311-4198, Japan
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13
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Takada J, Araki H, Ozawa N, Sugiyama T, Kubota M, Ibuka T, Shimizu M. Effective Treatment of Cytotoxic Agent Refractory Alpha-Fetoprotein-Producing Gastric Cancer with Ramucirumab: a Case Report and Review of the Literature. J Gastrointest Cancer 2019; 50:556-559. [PMID: 29250745 DOI: 10.1007/s12029-017-0043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jun Takada
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
| | - Hiroshi Araki
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Noritaka Ozawa
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Tomohiko Sugiyama
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masaya Kubota
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Takashi Ibuka
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Masahito Shimizu
- Department of Gastroenterology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
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Kyaw MTH, Yamaguchi Y, Choijookhuu N, Yano K, Takagi H, Takahashi N, Synn Oo P, Sato K, Hishikawa Y. The HDAC Inhibitor, SAHA, Combined with Cisplatin Synergistically Induces Apoptosis in Alpha-fetoprotein-producing Hepatoid Adenocarcinoma Cells. Acta Histochem Cytochem 2019; 52:1-8. [PMID: 30923410 PMCID: PMC6434315 DOI: 10.1267/ahc.18044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Hepatoid adenocarcinoma (HAC) is a rare and aggressive gastrointestinal tract cancer that is characterized by hepatic differentiation and production of alpha-fetoprotein (AFP). Cisplatin is mainly used to treat HAC, but the efficacy is poor. Recently, the histone deacetylase inhibitor, suberoylanilide hydroxamic acid (SAHA), was approved as an anticancer agent. In this study, we investigated the anticancer effect of SAHA in combination with cisplatin in VAT-39 cells, a newly established HAC cell line. Cell viability and apoptosis were examined by MTT assay, flow cytometry and TUNEL assay. Expression of H3S10, cleaved caspase-3, Bax, and Bcl-2 were evaluated by immunohistochemistry and western blotting. AFP levels were examined in VAT-39 cells and culture medium. Combined treatment with cisplatin and SAHA efficiently inhibited cell proliferation and decreased cell viability. Apoptotic cells, but not necrotic cells, were significantly increased following the combined treatment, and an increase in the Bax/Bcl-2 ratio indicated that the combination of cisplatin and SAHA induced apoptosis through the mitochondrial pathway. VAT-39 cells treated with cisplatin and SAHA also partially lost their main characteristic of AFP production. We conclude that cisplatin and SAHA have a synergistic anticancer effect of inducing apoptosis, and that this combination treatment may be effective for HAC.
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Affiliation(s)
- Myat Tin Htwe Kyaw
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
| | - Yuya Yamaguchi
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
| | - Narantsog Choijookhuu
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
| | - Koichi Yano
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
- Department of Surgery, Faculty of Medicine, University of Miyazaki
| | - Hideaki Takagi
- Division of Immunology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki
| | - Nobuyasu Takahashi
- Department of Anatomy, Ultrastructural Cell Biology, Faculty of Medicine, University of Miyazaki
| | - Phyu Synn Oo
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
- Department of Pathology, University of Medicine 1
| | - Katsuaki Sato
- Division of Immunology, Department of Infectious Diseases, Faculty of Medicine, University of Miyazaki
| | - Yoshitaka Hishikawa
- Department of Anatomy, Histochemistry and Cell Biology, Faculty of Medicine, University of Miyazaki
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15
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Maruyama S, Furuya S, Shiraishi K, Shimizu H, Akaike H, Hosomura N, Kawaguchi Y, Amemiya H, Kawaida H, Sudo M, Inoue S, Kono H, Ichikawa D. miR-122-5p as a novel biomarker for alpha-fetoprotein-producing gastric cancer. World J Gastrointest Oncol 2018; 10:344-350. [PMID: 30364858 PMCID: PMC6198302 DOI: 10.4251/wjgo.v10.i10.344] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/05/2018] [Accepted: 08/31/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate the clinical utility of alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC)-specific microRNA (miRNA) for monitoring and prognostic prediction of patients.
METHODS We performed a comprehensive miRNA array-based approach to compare miRNA expression levels between AFP-positive and AFP-negative cells in three patients with primary AFPGC. We next examined the expression levels of the selected miRNAs in five AFPGC and ten non-AFPGC tissue samples by quantitative reverse transcription-polymerase chain reaction to validate their utility. We also investigated the expression levels of the selected miRNA not only in tissue but also in plasma samples. Moreover, we investigated the relationship between plasma AFP levels and plasma selected miRNA expression levels, and also investigated the correlation of the selected miRNA expression levels and malignant potential.
RESULTS Among the five miRNAs selected from the miRNA array results, the expression levels of miR-122-5p were significantly higher in the AFPGC patients than in the non-AFPGC patients (P < 0.05). In tissue samples, miR-122-5p expression level tended to be lower in the non-AFPGC tissue than the normal gastric mucosa. Conversely, in the AFPGC tissue, miR-122-5p expression level was significantly higher in the AFPGC tissue than both the normal gastric mucosa and the non-AFPGC tissue samples (P < 0.05). Plasma miR-122-5p expression levels were also significantly higher in the AFPGC patients than the health volunteers and the non-AFPGC patients (P < 0.05) and were strongly correlated with plasma AFP levels (r = 0.7975, P < 0.0001). Moreover, the correlation of miR-122-5p expression in tissue samples with malignant potential was stronger than that of plasma AFP level in the AFPGC patients. In contrast, no correlation was found between miR-122-5p expression levels and liver metastasis in the non-AFPGC patients.
CONCLUSION miR-122-5p might be a useful biomarker for early detection and disease monitoring in AFPGC.
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Affiliation(s)
- Suguru Maruyama
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Kensuke Shiraishi
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiroki Shimizu
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidenori Akaike
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Naohiro Hosomura
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Makoto Sudo
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Shingo Inoue
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Hiroshi Kono
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine University of Yamanashi, Yamanashi 409-3898, Japan
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16
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Protein profiling of alpha-fetoprotein producing gastric adenocarcinoma. Oncotarget 2017; 7:28448-59. [PMID: 27057629 PMCID: PMC5053738 DOI: 10.18632/oncotarget.8571] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/28/2016] [Indexed: 12/14/2022] Open
Abstract
Alpha-fetoprotein (AFP) producing gastric adenocarcinoma is considered as a rare subtype of gastric adenocarcinoma. Compared with AFP non-producing gastric adenocarcinoma, our study and other previous studies showed that AFP producing gastric adenocarcinoma is more aggressive and prone to liver metastasis. Using the Protein Pathway Array, 11 of out of 286 proteins tested were found to be differentially expressed between AFP producing (n=32) and AFP non-producing (n=45) gastric adenocarcinoma tissues. In addition, the high level expression of XIAP and IGF-Irβ in gastric adenocarcinoma tissues was independent factors for poor prognosis in AFP producing gastric adenocarcinoma patients. A risk model based on the XIAP and IGF-Irβ expression levels can separate AFP producing gastric adenocarcinoma patients into 2 subgroups and each subgroup had a distinct set of signaling pathways involved. In conclusion, AFP producing gastric adenocarcinoma is a heterogeneous cancer with different clinical outcomes, biological behaviors and underlying molecular alterations.
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17
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Chen MY, Fang WL, Huang KH, Lai YH, Lin HJ. Influence of high serum alpha fetoprotein on patients with gastric cancer. ADVANCES IN DIGESTIVE MEDICINE 2017. [DOI: 10.1002/aid2.12050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Ming-Yao Chen
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; Taipei Taiwan
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Shuang Ho Hospital; New Taipei Taiwan
| | - Wen-Liang Fang
- Division of General Surgery; Department of Surgery, Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Kuo-Hung Huang
- Division of General Surgery; Department of Surgery, Taipei Veterans General Hospital; Taipei Taiwan
- School of Medicine; National Yang-Ming University; Taipei Taiwan
| | - Yu-Hsin Lai
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; Taipei Taiwan
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Shuang Ho Hospital; New Taipei Taiwan
| | - Hwai-Jeng Lin
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University; Taipei Taiwan
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Shuang Ho Hospital; New Taipei Taiwan
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18
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Bozkaya Y, Demirci NS, Kurtipek A, Erdem GU, Ozdemir NY, Zengin N. Clinicopathological and prognostic characteristics in patients with AFP-secreting gastric carcinoma. Mol Clin Oncol 2017; 7:267-274. [PMID: 28781800 DOI: 10.3892/mco.2017.1288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 05/16/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to determine whether there are any clinicopathological or prognostic differences between patients with α-fetoprotein-secreting gastric carcinoma (AFP-SGC) and non-AFP-SGC. Pathological parameters, clinical parameters, and treatment efficacy were compared in patients with AFP-SGC and non-AFP-SGC. In total, 362 patients (53 with AFP-SGC and 309 with non-AFP-SGC) were included in the present study. Patients with AFP-SGC had significantly higher levels of lymphovascular invasion, perineural invasion (PNI), rate of liver metastasis, and stage IV cancer compared with patients with non-AFP-SGC (P<0.05). The median overall survival (OS) rate was 12.6 months in the AFP-SGC group, and 22.1 months in the non-AFP-SGC group (P<0.001). The median OS and disease free survival (DFS) of patients with stage I-III AFP-SGC were 28.1 and 13.4 months, respectively, whereas for patients with non-AFP-SGC, the OS and DFS were 45.3 and 38.0 months, respectively (P=0.01; P=0.02). The median OS for the stage IV AFP-SGC and non-AFP-SGC groups was 9.3 and 11.5 months, respectively (P=0.14). Multivariate analysis of the entire patient group revealed that the Eastern Cooperative Oncology Group (ECOG) performance score of ≥2, lymph node involvement, presence of PNI, high levels of carcinoembryonic antigen, and distant metastasis were significantly correlated with OS. The lymph node involvement, ECOG performance score of ≥2, AFP-SGC type, and weight loss at diagnosis were also significant factors influencing the DFS in the stage I-III group. In conclusion, patients with AFP-SGC had more aggressive clinicopathological features and biological behavior with an increased tendency of liver metastasis compared with patients with non-AFP-SGC. In the near future, AFP may become an important surrogate marker to manage therapies of patients with gastric cancer.
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Affiliation(s)
- Yakup Bozkaya
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nebi Serkan Demirci
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Alican Kurtipek
- Department of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Gökmen Umut Erdem
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nuriye Yildirim Ozdemir
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
| | - Nurullah Zengin
- Department of Medical Oncology, Ankara Numune Education and Research Hospital, Ankara, Turkey
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Li Z, Hou X, Chen J, Sun H, Mi Y, Sui Y, Li Y, Xie J, Qiao Y, Lei X, Che X, Liu J. Efficacy and safety of SOX chemotherapy with or without surgery in AFP-producing advanced gastric cancer. Oncol Lett 2017; 14:579-586. [PMID: 28693208 PMCID: PMC5494698 DOI: 10.3892/ol.2017.6240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/16/2017] [Indexed: 12/17/2022] Open
Abstract
The present study investigated the clinical efficacy of S-1 plus oxaliplatin (SOX) regimen, with or without surgery in α-fetoprotein-producing gastric cancer (APGC) with liver metastasis. A total of 24 patients with APGC treated at the Liaocheng People's Hospital between January 2011 and December 2013 were retrospectively reviewed. Clinical efficacy and patient safety were compared between the two groups. The median progression-free survival (PFS) and overall survival (OS) in the SOX group were 6.5 [95% confidence interval (CI), 4.6–8.4] and 13.5 (95% CI, 8.1–18.9) months, respectively. The corresponding indicators in the SOX and surgery group were 7.0 (95% CI, 5.7–8.3) and 14 (95% CI, 11.0–17.1) months, respectively. There was no significant difference in PFS and OS between the two groups (P=0.703 and 0.710, respectively). The adverse effects of leucopenia, neutropenia, anemia and diarrhea occurred in ~10% of patients in the SOX group and in 14.3% (2/14), 7.14% (1/14), 14.3% (2/14) and 7.14% (1/14), respectively, in the surgery group. No significant difference was identified between groups in terms of overall incidence of adverse effects (P=0.17). However, severe adverse events, including gastroplegia, pancreatic fistula, pulmonary infection and refractory ascites, occurred only in the SOX plus surgery group [incidence rate for severe adverse events, 7.14% (1/14); P<0.001 between groups]. In conclusion, SOX chemotherapy is safe and effective in patients with APGC and liver metastasis. However, the addition of surgery to SOX chemotherapy may not improve the disease control rate and may increase the adverse effects.
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Affiliation(s)
- Zhu Li
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Xu Hou
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Juan Chen
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Huidong Sun
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Yuetang Mi
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Yongling Sui
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Yuhong Li
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Jiaping Xie
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Yingli Qiao
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Xiaofeng Lei
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Xiaoshuang Che
- Department of General Surgery, Liaocheng People's Hospital/Affiliated Liaocheng Hospital, Shandong University, Liaocheng, Shandong 252000, P.R. China
| | - Jun Liu
- Department of Liver Transplantation and Hepatobiliary Surgery, Shandong Provincial Hospital Affiliated, Shandong University, Jinan, Shandong 250021, P.R. China
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Bozkaya Y, Doğan M, Yazıcı O, Erdem GU, Demirci NS, Zengin N. The efficacy of modified docetaxel-cisplatin-5-fluorouracil regimen as first-line treatment in patients with alpha-fetoprotein producing gastric carcinoma. Bosn J Basic Med Sci 2017; 17:138-143. [PMID: 28273032 DOI: 10.17305/bjbms.2017.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 02/01/2023] Open
Abstract
Alpha-fetoprotein producing gastric carcinoma (AFP-PGC) is a rare cancer for which limited data on the clinicopathological features and treatment modalities exist. The aim of this study was to compare the efficacy of modified docetaxel-cisplatin-5-fluorouracil (mDCF) as the first-line chemotherapy regimen in metastatic AFP-PGC and non-AFP-PGC. The patients diagnosed with metastatic gastric cancer who were given mDCF as first-line therapy were retrospectively reviewed. The patients with a basal serum AFP level over 9 ng/ml were defined as AFP-PGC patients. In total, 169 patients (34 with AFP-PGC and 135 with non-AFP-PGC) were included in this study. AFP-PGC patients had more liver metastases than non-AFP-PGC patients (p < 0.001). A decrease in basal AFP levels after three cycles of chemotherapy was significantly different in AFP-PGC group (p = 0.001).Overall disease control rate was 79.4% (partial response [PR] - 44.1%, stable disease [SD] - 35.3%), and 82.2% (complete response - 3%, PR - 36.2%, SD - 43%) in AFP-PGC and non-AFP-PGC patients, respectively. There was no difference between AFP-PGC and non-AFP-PGC groups in overall and progression-free survival rates (11.3 versus 11.4 months and 7.7 versus 7.1 months, respectively). Rates of grade 3-4 hematologic toxicity were 8.8% and 6.7% for neutropenia in AFP-PGC and non-AFP-PGC group, respectively and 5.9% and 7.4% for anemia. In conclusion, mDCF regimen is well-tolerated with acceptable toxicity outcomes in both AFP-PGC and non-AFP-PGC patients. A statistically significant decrease in AFP levels after mDCF regimen indicate that AFP might be considered as a supplemental marker of response to mDCF chemotherapy in AFP-PGC patients. However, further prospective clinical trials are required in this area.
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Affiliation(s)
- Yakup Bozkaya
- Department of Medical Oncology, Ankara Numune Training and Research Hospital, Ankara, Turkey.
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21
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Sun N, Sun Q, Liu Q, Zhang T, Zhu Q, Wang W, Cao M, Zang QI. α-fetoprotein-producing gastric carcinoma: A case report of a rare subtype and literature review. Oncol Lett 2016; 11:3101-3104. [PMID: 27123071 DOI: 10.3892/ol.2016.4372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 02/19/2016] [Indexed: 12/13/2022] Open
Abstract
α-fetoprotein (AFP)-producing gastric carcinoma is a rare type of gastric cancer, and the characteristics have not yet been fully elucidated. The present study reports the case of a patient with this type of gastric cancer. A 66-year-old male was referred to the Department of Gastrointestinal Surgery, Qianfoshan Hospital, Shandong University (Jinan, China) with a 20-day history of retrosternal pain. A computed tomography (CT) scan revealed a thickening of the wall of the cardia and massive lymph node swelling in the region of the lesser curvature of the stomach. A laboratory investigation revealed that the serum AFP levels of the patient were elevated to 46.49 ng/ml (normal level, <12.00 ng/ml), and the serum carcinoembryonic antigen (CEA) levels were 382.22 ng/ml (normal range, <5.00 ng/ml). An endoscopy revealed an elevated tumor and AFP-producing gastric cancer was diagnosed. As the tumor was surgically unresectable, the patient received systemic adjuvant chemotherapy [consisting of 1 cycle of oxaliplatin (150 mg; day 1)-fluorouracil(1.0 g; days 2-6)-calcium folinate (0.3 g; days 2-6), 4 cycles of paclitaxel (80 mg; day 1 and 8, repeated day 21) and capecitabine (1,000 g/m2, twice daily; days 1-14, repeated day 21), and 2 cycles of oxaliplatin (130 mg/m2; day 1, repeated day 21) and S-1 (100 mg/d; day 1- day 14; repeated day 21)]. During the chemotherapy intermission, the patient experienced partial remission; the serum AFP levels remained between 44.5 and 32.7 ng/ml, and serum CEA levels decreased to a normal level. The CT scan revealed that the enlarged lymph nodes of the patient had decreased in size. During the preoperative examinations, an abdominal CT scan revealed no metastasis to the liver. A radical gastrectomy was performed on October 20, 2014. Additionally, the tumor did not demonstrate the diffusion of AFP. The histopathological examination revealed a poorly differentiated adenocarcinoma, with local and neuroendocrine differentiation and no hepatoid features. According to these histopathological findings, the tumor was diagnosed as AFP-producing non-hepatoid adenocarcinoma of the stomach. The patient was treated with systemic immunity-enhancing therapy and has been free of recurrence for 2 months. The present study describes a rare case of AFP-producing non-hepatoid adenocarcinoma of the stomach, with a review of the literature and an investigation of the clinical features.
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Affiliation(s)
- Ningbo Sun
- Division of Surgery, Graduate Department, Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Qing Sun
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
| | - Qun Liu
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
| | - Tianxiao Zhang
- Division of Surgery, Graduate Department, Weifang Medical College, Weifang, Shandong 261031, P.R. China
| | - Qiang Zhu
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
| | - Wei Wang
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
| | - Ming Cao
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
| | - Q I Zang
- Department of Thoracic Surgery, Qianfoshan Hospital, Shandong University, Jinan, Shandong 250014, P.R China
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Tatli AM, Urakci Z, Kalender ME, Arslan H, Tastekin D, Kaplan MA. Alpha-fetoprotein (AFP) elevation gastric adenocarcinoma and importance of AFP change in tumor response evaluation. Asian Pac J Cancer Prev 2015; 16:2003-7. [PMID: 25773802 DOI: 10.7314/apjcp.2015.16.5.2003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Elevated serum alpha-fetoprotein (AFP) levels in adults are considered abnormal. This parameter is used mostly in the diagnosis and follow-up of hepatocellular carcinomas and yolk sac tumors. Among the other rare tumors accompanied with elevated serum AFP levels, gastric cancer is the most common. In this study, we evaluated the follow-up and comparison of the treatment and marker response of patients with metastatic gastric cancer who had elevated serum AFP levels. MATERIALS AND METHODS We performed a retrospective study, including all consecutive patients with advanced gastric cancer, who received systemic chemotherapy with elevated AFP level. RESULTS Seventeen metastatic gastric cancer patients with elevated AFP levels at the time of diagnosis were evaluated. Fourteen (82.4%) were males and three (17.6%) were females. The primary tumor localization was the gastric body in 8 (76.4%), cardia in 7 (41.2%), and antrum in 2 (11.8%). Hepatic metastasis was observed in 13 (76.4%) at the time of diagnosis. When the relationship of AFP levels and carcinoembryonic antigen (CEA) response of the patients with their radiologic responses was evaluated, it was found that the radiologic response was compatible with AFP response in 16 (94.1%) patients and with CEA response in 12 (70.6%); however, in 5 (29.4%) patients no accordance was observed between radiological and CEA responses. CONCLUSIONS Follow-up of AFP levels in metastatic gastric cancer patients with elevated AFP levels may allow prediction of early treatment response and could be more useful than the CEA marker for follow-up in response evaluation.
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Affiliation(s)
- Ali Murat Tatli
- Department Oncology Medical, Van Training and Research Hospital, Van, Turkey E-mail :
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Regional Arterial Infusion Chemotherapy improves the Pathological Response rate for advanced gastric cancer with Short-term Neoadjuvant Chemotherapy. Sci Rep 2015; 5:17516. [PMID: 26620627 PMCID: PMC4664910 DOI: 10.1038/srep17516] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/30/2015] [Indexed: 12/29/2022] Open
Abstract
To identify clinicopathologic and treatment variables that could predict pathologic tumor response to short-term neoadjuvant chemotherapy (NAC) for patients with locally advanced gastric cancer. A retrospective analysis was conducted of 178 patients who underwent short-term NAC with EOX regimen followed by surgery from January 2008 to December 2010. Neoadjuvant treatment response was evaluated using tumor regression grade. Relationships between pathologic tumor response and clinicopathological factors were evaluated using logistic regression analysis. The benefits of regional arterial infusion chemotherapy were investigated separately. The postoperative pathological response rate was 46.1% (82/178) and 4 patients (2.2%) had complete pathological remission. Pathological response was significantly associated with tumor differentiation (P = 0.008), abnormal a-fetoprotein levels (P = 0.01) and administration approach to chemotherapy (intravenous versus regional arterial infusion chemotherapy) (P = 0.018). Most bone marrow toxicities, vomiting, nausea, alopecia, and fatigue were acceptable. Grade 3/4 toxicities were not commonly observed. The 3-year overall survival (OS) and recurrence free survival (RFS) were 67.0% and 53.0%, respectively. Regional arterial infusion NAC group had significantly better median RFS (48.0 versus 34.0 months) than the intravenous NAC group (P = 0.049). In conclusion, regional arterial infusion NAC can improve the pathological response rate of advanced gastric cancer treated with EOX regimen.
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24
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High level of serum AFP is an independent negative prognostic factor in gastric cancer. Int J Biol Markers 2015; 30:e387-93. [PMID: 26349668 DOI: 10.5301/jbm.5000167] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Gastric cancer with a high level of serum alpha fetoprotein (AFP) is uncommon and has unique clinicopathological features and a poorer prognosis. The aim of this research was to elucidate the clinicopathological and prognostic features of gastric cancer with a high level of AFP. METHODS The sera from 1,286 patients with gastric cancer treated at Qilu Hospital of Shandong University from January 2004 to December 2008 were analyzed preoperatively for AFP, CEA and CA19-9 levels after excluding active or chronic hepatitis, liver cirrhosis and hepatocellular carcinoma as well as preoperative distant metastasis. Patients were divided into 2 groups: 86 serum AFP-positive patients and 1,200 serum AFP-negative patients according to a cutoff of 20 ng/mL. The clinicopathological features and prognostic factors were compared between the groups. RESULTS A higher incidence of serosal invasion, lymph node metastasis and liver metastasis and poorer prognosis was observed in the AFP-positive group compared with the AFP-negative group (all p<0.05). Serum AFP showed the highest specificity (93.66%) and diagnostic accuracy (92.38%) for predicting liver metastasis among the 3 tumor markers examined. Multivariate survival analysis revealed that AFP positivity was an independent prognostic factor in all 1,286 gastric cancer patients. The prognosis of AFP-positive gastric cancer was poorer than that of AFP-negative gastric cancer (p<0.05). CONCLUSIONS A high level of serum AFP is an independent prognostic factor in gastric cancer and can be used for evaluating the prognosis of gastric cancers whether in the presence or absence of liver metastasis.
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Fang YU, Wang L, Yang N, Gong X, Zhang YU, Qin S. Successful multimodal therapy for an α-fetoprotein-producing gastric cancer patient with simultaneous liver metastases. Oncol Lett 2015; 10:3021-3025. [PMID: 26722283 DOI: 10.3892/ol.2015.3731] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 07/28/2015] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Y U Fang
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
| | - Lin Wang
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
| | - Ningrong Yang
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
| | - Xinlei Gong
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
| | - Y U Zhang
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
| | - Shukui Qin
- Department of Medical Oncology, 81st Hospital of the People's Liberation Army, Nanjing, Jiangsu 210002, P.R. China
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Asahi Y, Kamiyama T, Homma S, Hatanaka KC, Yokoo H, Nakagawa T, Kamachi H, Nakanishi K, Tahara M, Kakisaka T, Wakayama K, Todo S, Taketomi A. Resection of liver metastasis derived from alpha-fetoprotein-producing gastric cancer-report of 4 cases. Int Cancer Conf J 2015; 5:98-103. [PMID: 31149434 DOI: 10.1007/s13691-015-0236-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/19/2015] [Indexed: 12/22/2022] Open
Abstract
As is the case for metastatic liver tumors derived from standard gastric cancers, there is no consensus about the optimal treatment for metastatic liver tumors derived from alpha-fetoprotein (AFP)-producing gastric cancer, including regarding the surgical indications for such lesions. We report the cases of 4 patients in whom metastatic liver tumors derived from AFP-producing gastric cancer that were curatively resected. One of the patients had a thrombus in his inferior vena cava at the time of the liver resection, and both the liver tumor and thrombus were completely removed. The patient has survived 93 months after receiving multidisciplinary therapy including partial pneumonectomy, chemotherapy, and radiotherapy and currently has no evaluable disease. Another patient has survived for 3 years without suffering any recurrence. Since long-term survival is possible, liver resection should be considered as a treatment for liver metastases from AFP-producing gastric cancers.
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Affiliation(s)
- Yoh Asahi
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Toshiya Kamiyama
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Shigenori Homma
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Kanako C Hatanaka
- 2Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Yokoo
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Takahito Nakagawa
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Hirofumi Kamachi
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Kazuaki Nakanishi
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Munenori Tahara
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Tatsuhiko Kakisaka
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Kenji Wakayama
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Satoru Todo
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
| | - Akinobu Taketomi
- 1Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Kita-ku, Kita 14, Nishi 5, Sapporo, 060-8648 Japan
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Wang D, Li C, Xu Y, Xing Y, Qu L, Guo Y, Zhang Y, Sun X, Suo J. Clinicopathological characteristics and prognosis of alpha-fetoprotein positive gastric cancer in Chinese patients. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2015; 8:6345-6355. [PMID: 26261510 PMCID: PMC4525844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 05/29/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE This study aimed to review the clinicopathological, histochemical, and prognostic features of Alpha-Fetoprotein (AFP) positive gastric cancer. PATIENTS AND METHODS Six hundred and fifty one patients with gastric cancer who underwent gastrectomy between January 2009 and December 2012 at The First Hospital of Jilin University were enrolled in the study. Among them, 45 patients were identified as AFP positive gastric cancer. The clinicopathologic characteristics and prognosis of the AFP positive gastric cancer patients were analyzed. RESULTS Among the 45 AFP positive patients, serum levels of AFP were < 100 µg/L in nine patients. The histological classification of 45 patients was as follows: hepatoid type, 25 (55.6%) cases; fetal gastrointestinal type, 12 (26.7%) cases; yolk sac tumor type, 2 (4.4%) cases; and mixed type, 6 (13.3%) cases. Twenty nine (64.4%) cases were AFP positive by immunohistochemical analysis; we found no significant difference in AFP positivity and histologic type. However, the differences in the number of metastasis lymph nodes, the maximum tumor diameter, pathological stage, vascular invasion and liver metastasis between the AFP positive group and the negative group were significant. At the same T stage, the liver metastasis status of the AFP positive group was higher than that of the negative group. The AFP positive group had a much poorer prognosis than the negative group. CONCLUSION AFP positive gastric cancer is associated with aggressive behavior and poorer prognosis compared to that of AFP negative gastric cancer.
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Affiliation(s)
- Daguang Wang
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Chunping Li
- Department of Anesthesiology, The First Hospital, Jilin UniversityChangchun, China
| | - Yuechao Xu
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Yanpeng Xing
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Limei Qu
- Department of Pathology, The First Hospital, Jilin UniversityChangchun, China
| | - Yuchen Guo
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Yang Zhang
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Xuan Sun
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
| | - Jian Suo
- Department of Gastrointestinal Surgery, The First Hospital, Jilin UniversityChangchun, China
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Wu QY, Wan XY, Xie X, Lu BJ. Endometrial hepatoid adenocarcinoma: a rare cause of elevated serum α-fetoprotein. J Obstet Gynaecol Res 2015; 40:873-7. [PMID: 24738133 DOI: 10.1111/jog.12237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Hepatoid adenocarcinoma is a rare and unusual tumor in the female genital tract. Hepatoid adenocarcinoma resembles hepatocellular carcinoma morphologically but develops in extrahepatic organs, and usually demonstrates foci of adenocarcinoma of the primary organ. Tumor cells often stain positive for anti-α-fetoprotein antibody, and may be associated with elevated serum α-fetoprotein, which may be useful as a tumor marker to guide treatment. There is little reliable information to guide clinical management of these unusual tumors and prognosis is poor despite multi-modal treatment. This report describes the diagnosis and treatment of this tumor in a postmenopausal woman.
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Lew DH, Jung WT, Kim HJ, Min HJ, Ha CY, Kim HJ, Kim TH, Ko GH. [Clinicopathological characteristics and prognosis of alpha-fetoprotein producing gastric cancer]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2014; 62:327-35. [PMID: 24365731 DOI: 10.4166/kjg.2013.62.6.327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Several studies reported a subgroup of gastric cancer patients showing elevated serum alpha-fetoprotein (AFP) at the time of diagnosis. We investigated the clinicopathological characteristics and prognostic factors of AFP producing gastric cancer (AFPPGC) by comparing with AFP non-producing gastric cancer (AFPNPGC). METHODS A total of 909 patients were diagnosed with gastric cancer from January 2005 to March 2013 at Gyeongsang National University Hospital and their AFP levels were measured at the time of diagnosis. After excluding 138 patients with underlying liver diseases, 34 patients with elevated serum AFP level over 10 mg/mL were assigned to AFPPGC group and the remaining 737 patients with serum level of AFP below 10 ng/mL were assigned to AFPNPGC group. RESULTS The median survival length was shorter in AFPPGC group than AFPNPGC group (18.3 ± 25.5 months vs. 30.0 ± 22.0 months, p=0.004). The incidence of liver metastasis (47.1% vs. 3.3%, p<0.001) and lymph node metastasis (91.2% vs. 31.6%, p<0.001) was significantly higher in AFPPGC group. The probability of encountering metachronous liver metastasis after the operation was higher in AFPPGC group (44.4% vs. 2.0%, p<0.001). Multivariate analysis revealed that patients in the AFPPGC group who received chemotherapy (p=0.037) or underwent operation (p=0.001) had a better survival rate. CONCLUSIONS AFPPGC behaves more aggressively and shows a worse prognosis. Therefore, serum AFP level should be routinely checked in all patients diagnosed with gastric cancer.
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Affiliation(s)
- Dong Hoon Lew
- Department of Internal Medicine, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 660-702, Korea
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Lin HJ, Hsieh YH, Fang WL, Huang KH, Li AFY. Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer. ACTA ACUST UNITED AC 2014; 21:e394-9. [PMID: 24940098 DOI: 10.3747/co.21.1768] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with alpha-fetoprotein (afp)-producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients. METHODS Our study enrolled patients who, before surgery, had gastric cancer with serum afp exceeding 20 ng/mL [afp>20 (n = 58)] and with serum afp 20 ng/mL or less [afp≤20 (n = 1236)]. Clinical manifestations were compared between the groups. RESULTS Early gastric cancer was more frequent (30.1% vs. 4%) and advanced gastric cancer was less frequent (69.9% vs. 96%) in the afp≤20 group than the afp>20 group (p < 0.001). Liver and lymph node metastasis occurred less frequently in the afp≤20 group (4.4% vs. 27.6%, p < 0.001, and 60.7% vs. 91.4%, p < 0.001, respectively). The 1-, 3-, 5-, and 10-year survival rates of afp≤20 patients were 75.2%, 53.4%, 45.8%, and 34.6% respectively. The 1-, 3-, 5-, and 10-year survival rates of patients with afp greater than 20 ng/mL, but 300 ng/mL or less, were 46.7%, 28.9%, 17.8%, and 13.3% respectively. The 1-, 3-, and 5-year survival rates of patients with serum afp greater than 300 ng/mL were 15.4%, 7.7%, and 0% respectively. The independent predictors for survival time were afp concentration, age, peritoneal seeding, liver metastasis, lymph node metastasis, vascular invasion, TNM stage, curative surgery, serosal invasion, and Lauren classification. CONCLUSIONS Patients with high serum afp had a high frequency of liver and lymph node metastasis and very poor prognosis. More aggressive management with multimodal therapy (for example, chemotherapy, radiotherapy) might be needed when treating such patients.
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Affiliation(s)
- H J Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. ; School of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Y H Hsieh
- Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan. ; Buddhist Tzu Chi University, School of Medicine, Hualien City, Taiwan
| | - W L Fang
- Division of General Surgery, Veterans General Hospital-Taipei, Taipei City, Taiwan. ; School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - K H Huang
- Division of General Surgery, Veterans General Hospital-Taipei, Taipei City, Taiwan. ; School of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - A F Y Li
- School of Medicine, National Yang-Ming University, Taipei City, Taiwan. ; Department of Pathology, Veterans General Hospital-Taipei, Taipei City, Taiwan
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Liu X, Yu H, Cai H, Wang Y. Expression of CD24, p21, p53, and c-myc in alpha-fetoprotein-producing gastric cancer: Correlation with clinicopathologic characteristics and survival. J Surg Oncol 2014; 109:859-64. [PMID: 24619835 DOI: 10.1002/jso.23599] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 02/10/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to evaluate the expression of CD24, p21, p53, and c-myc in lesions of patients with Alpha-Fetoprotein (AFP)-producing gastric cancer and their correlation with clinicopathological features and prognosis. METHODS One hundred and four patients with AFP-producing gastric cancer were included into this study. The levels of CD24, p21, p53, and c-myc were examined by immunohistochemistry.The prognostic value of these biological markers and the correlation between biological markers and clinicopathological factors were investigated. RESULTS The percentages of positive expression of CD24, p21, p53, and c-myc were 31.7%, 77.9%, 75.0%, and 66.3%, respectively. CD24 expression correlated with histological grade (P = 0.045) and Lauren type (P = 0.006); p21expression with Borrmann type (P = 0.035); c-myc expression with Borrmann type (P = 0.029). p21 expression was related with poor survival in univariate analysis (P = 0.016). Multivariate analysis showed that p21 expression, vascular invasion, and pathological stage were defined as independent prognostic factors. CONCLUSION The expression of p21 was an independent prognostic factor for patients with AFP-producing gastric cancer.
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Affiliation(s)
- Xiaowen Liu
- Department of Gastric Cancer and Soft Tissue Sarcoma, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Novel permissive cell lines for complete propagation of hepatitis C virus. J Virol 2014; 88:5578-94. [PMID: 24599999 DOI: 10.1128/jvi.03839-13] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED Hepatitis C virus (HCV) is a major etiologic agent of chronic liver diseases. Although the HCV life cycle has been clarified by studying laboratory strains of HCV derived from the genotype 2a JFH-1 strain (cell culture-adapted HCV [HCVcc]), the mechanisms of particle formation have not been elucidated. Recently, we showed that exogenous expression of a liver-specific microRNA, miR-122, in nonhepatic cell lines facilitates efficient replication but not particle production of HCVcc, suggesting that liver-specific host factors are required for infectious particle formation. In this study, we screened human cancer cell lines for expression of the liver-specific α-fetoprotein by using a cDNA array database and identified liver-derived JHH-4 cells and stomach-derived FU97 cells, which express liver-specific host factors comparable to Huh7 cells. These cell lines permit not only replication of HCV RNA but also particle formation upon infection with HCVcc, suggesting that hepatic differentiation participates in the expression of liver-specific host factors required for HCV propagation. HCV inhibitors targeting host and viral factors exhibited different antiviral efficacies between Huh7 and FU97 cells. Furthermore, FU97 cells exhibited higher susceptibility for propagation of HCVcc derived from the JFH-2 strain than Huh7 cells. These results suggest that hepatic differentiation participates in the expression of liver-specific host factors required for complete propagation of HCV. IMPORTANCE Previous studies have shown that liver-specific host factors are required for efficient replication of HCV RNA and formation of infectious particles. In this study, we screened human cancer cell lines for expression of the liver-specific α-fetoprotein by using a cDNA array database and identified novel permissive cell lines for complete propagation of HCVcc without any artificial manipulation. In particular, gastric cancer-derived FU97 cells exhibited a much higher susceptibility to HCVcc/JFH-2 infection than observed in Huh7 cells, suggesting that FU97 cells would be useful for further investigation of the HCV life cycle, as well as the development of therapeutic agents for chronic hepatitis C.
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Shimada H, Noie T, Ohashi M, Oba K, Takahashi Y. Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association. Gastric Cancer 2014; 17:26-33. [PMID: 23572188 DOI: 10.1007/s10120-013-0259-5] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 03/24/2013] [Indexed: 02/06/2023]
Abstract
The aim of this review was to evaluate the clinical significance of serum tumor markers, particularly CEA, CA19-9, and CA72-4, in patients with gastric cancer. A systematic literature search was performed using PubMed/MEDLINE with the keywords "gastric cancer" and "tumor marker," to select 4,925 relevant reports published before the end of November 2012. A total of 187 publications contained data for CEA and CA19-9, and 19 publications contained data related to all three tumor markers. The positive rates were 21.1 % for CEA, 27.8 % for CA19-9, and 30.0 % for CA72-4. These three markers were significantly associated with tumor stage and patient survival. Serum markers are not useful for early cancer, but they are useful for detecting recurrence and distant metastasis, predicting patient survival, and monitoring after surgery. Tumor marker monitoring may be useful for patients after surgery because the positive conversion of tumor markers usually occurs 2-3 months before imaging abnormalities. Among other tumor markers, alpha-fetoprotein (AFP) is useful for detecting and predicting liver metastases. Moreover, CA125 and sialyl Tn antigens (STN) are useful for detecting peritoneal metastases. Although no prospective trial has yet been completed to evaluate the clinical significance of these serum markers, this literature survey suggests that combinations of CEA, CA19-9, and CA72-4 are the most effective ways for staging before surgery or chemotherapy. In particular, monitoring tumor markers that were elevated before surgery or chemotherapy could be useful for detection of recurrence or evaluation of the response.
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Affiliation(s)
- Hideaki Shimada
- Department of Surgery, School of Medicine, Toho University, 6-11-1 Omori-Nishi, Ota-ku, Tokyo, 143-8541, Japan,
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Hirajima S, Komatsu S, Ichikawa D, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Konishi H, Ikoma H, Otsuji E. Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer. World J Gastroenterol 2013; 19:6055-6061. [PMID: 24106406 PMCID: PMC3785627 DOI: 10.3748/wjg.v19.i36.6055] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/19/2013] [Accepted: 08/09/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate differences between common gastric cancer and α-fetoprotein (AFP)-producing gastric cancer according to the presence or absence of liver metastasis.
METHODS: Between 1997 and 2011, 1299 patients underwent gastrectomy for gastric cancer (GC) at our institute and their hospital records were reviewed retrospectively. Patients were immunohistochemically divided into two groups: 23 patients (1.8%) with AFP-producing GC and 1276 patients (98.2%) without it.
RESULTS: AFP-producing GC patients had a significantly higher incidence of deeper tumors, venous invasion, lymphatic invasion, lymph node metastasis, and liver metastasis and a poorer prognosis (P < 0.005) than those without AFP-producing GC. However, multivariate analysis revealed that AFP-positivity was not an independent prognostic factor. The prognosis of AFP-producing GC was similar to that of AFP-non producing GC according to the presence or absence of liver metastasis. Concerning recurrence, 47.8% of patients (11/23) with AFP-producing GC and 20.0% of patients (256/1276) without AFP-producing GC exhibited recurrence. Liver metastasis [90.9% (10/11)] was the most prevalent in AFP-producing GC patients. Multivariate analysis revealed that liver metastasis was the only independent prognostic factor in AFP-producing GC (HR = 17.6, 95%CI: 2.1-147.1; P = 0.0081).
CONCLUSION: AFP-producing GC is similar to common GC without liver metastasis, which should be specifically targeted in an effort to improve the prognosis of AFP-producing GC patients.
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Koneri K, Hirono Y, Fujimoto D, Sawai K, Morikawa M, Murakami M, Goi T, Iida A, Katayama K, Yamaguchi A. Five-year survival of alpha-fetoprotein-producing gastric cancer with synchronous liver metastasis: a case report. J Gastric Cancer 2013; 13:58-64. [PMID: 23610720 PMCID: PMC3627808 DOI: 10.5230/jgc.2013.13.1.58] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 02/13/2013] [Accepted: 02/13/2013] [Indexed: 11/20/2022] Open
Abstract
Alpha-fetoprotein-Producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.
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Affiliation(s)
- Kenji Koneri
- Department of Gastroenterological Surgery, University of Fukui, Fukui, Japan
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