Korean J Gastroenterol.  2013 Dec;62(6):327-335. 10.4166/kjg.2013.62.6.327.

Clinicopathological Characteristics and Prognosis of Alpha-fetoprotein Producing Gastric Cancer

• Lew DH
• Jung WT
• Kim HJ
• Min HJ
• Ha CY
• Kim HJ
• Kim TH
• Ko GH

• KMID: 1711288
• DOI: http://doi.org/10.4166/kjg.2013.62.6.327

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.

Keyword

Alpha-Fetoproteins; Stomach neoplasms; Prognosis

MeSH Terms

Aged
Aged, 80 and over
Female
Humans
Liver Neoplasms/secondary
Lymphatic Metastasis
Male
Middle Aged
Neoplasm Staging
Prognosis
Proportional Hazards Models
Smoking
Stomach Neoplasms/*diagnosis/mortality/pathology
Survival Rate
Treatment Outcome
alpha-Fetoproteins/*metabolism
alpha-Fetoproteins

Figure

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  Fig. 1. Patient selection.

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  Fig. 2. (A) Immunohistochemical staining in AFP-producing gastric cancer. Gastric adenocarcinoma cells express AFP in the cytoplasm of some tumor cells and in the glandular lumina (AFP, ×100). (B) Immunohistochemical staining in AFP non-producing gastric cancer. Gastric adenocarcinoma in this case is negative for AFP (×100).

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  Fig. 3. Survival of gastric cancer patients compared with those of the same stage according to AFP production. Survival of AFPPGC is shorter than that of AFPNPGC with same stage. AFPPGC, AFP producing gastric cancer; AFPNPGC, AFP non-producing gastric cancer.

Reference

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