Abstract
Serum α-fetoprotein- (AFP-) elevated gastric cancer is a rare tumor that has a poor prognosis due to high incidence of liver metastasis. This study sought to investigate the optimal treatment modality. A total of 319 gastric cancer patients with liver metastasis (GCLM) whose serum AFP levels were tested before treatment were enrolled in this study. They were classified as the serum AFP ≥ 20 ng/ml group (n = 74) and the AFP < 20 ng/ml group (n = 245). Median OS of the AFP < 20 ng/ml group was significantly longer than that of the AFP ≥ 20 ng/ml group (15.7 m versus 10.9 m, P = 0.004). ORR of first-line chemotherapy was 43.3% and 56.1% of the two groups, respectively (P = 0.024). Of patients who received doublet regimen, ORR of the AFP ≥ 20 ng/ml group was significantly lower (38.2 versus 56.9%, P = 0.013), while in those received triplet regimens, ORR between two groups was similar (66.7% versus 66.7%, P = 0.676). Moreover, for patients of the AFP ≥ 20 ng/ml group, those who reached PR had a longer survival period (15.4 m versus 9.4 m, P = 0.017), and combined with local treatment for liver metastasis also seemed to improve prognosis (19.2 m versus 8.4 m, P = 0.003). In conclusion, serum AFP-elevated GCLM had a poorer prognosis. Multimodality treatment including aggressive first-line chemotherapy with triplet regimen may be needed when treating them.
Highlights
Serum α-fetoprotein (AFP) has been proposed as a tumor marker for screening liver tumor and germ cell tumors in the clinic [1,2,3]. 70–95% of hepatocellular cancers are associated with increased AFP level
Compared with the serum AFP < 20 ng/ml group, 10 (13.5%) patients were diagnosed with hepatoid adenocarcinoma in the AFP ≥ 20 ng/ml group
Gastric hepatoid adenocarcinoma (GHA) was defined as a special subtype of primary gastric adenocarcinoma characterized by the histologic structures of “hepatocellular carcinoma- (HCC-) like differentiation” with or without excessive production of AFP [14, 15]
Summary
Serum α-fetoprotein (AFP) has been proposed as a tumor marker for screening liver tumor and germ cell tumors in the clinic [1,2,3]. 70–95% of hepatocellular cancers are associated with increased AFP level. 70–95% of hepatocellular cancers are associated with increased AFP level. Serum AFP-elevated gastric cancer was first reported by Alpert et al in 1970 [4]. The incidence of AFP-producing gastric cancer was merely 1.3–15.0% worldwide [5]. The gastric cancer patients with serum AFP elevation were found to have doughty invasiveness and poor prognosis [6,7,8,9]. Liu et al reported that the dismal prognosis of serum AFP-elevated gastric cancer was mainly due to high incidence of synchronous and metachronous liver metastasis, even when radical operation was done [5]. Systemic chemotherapy became the predominant treatment method for serum AFP-elevated gastric cancer with liver metastasis (GCLM)
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