Survival analysis and clinical characteristics of forty-eight patients with alpha-fetoprotein-positive gastric cancer treated by integrated Chinese and western medicine.

Abstract

e15550 Background: Alpha-fetoprotein-producing gastric carcinoma (AFPGC) is a special type of gastric cancer, which has characteristics of strong invasiveness, prone to liver and lymphnode metastasis, easy misdiagnosis and worse prognosis. According to the literature, the survival of AFPGC was 4-14 months (m). There is no report about integrated Chinese and Western Medicine on the AFPGC patients. This study is to explore the effect of integrated Chinese and Western Medicine on the survival and clinical characteristics of patients with AFPGC. Methods: 398 consecutive patients with gastric cancer admitted to Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from Jan 2012 to Jun 2018 were retrospectively collected. All patients were diagnosed by pathology. And on the basis treatment of conventional Western Medicine combined with Chinese Medicine for more than 3 m. Follow-up up to Dec 31th 2018. The median follow-up time was 11.1 m. According to the results of serum alpha-fetoprotein chemiluminescence assay, AFPGC was found in 48 out of 398 patients. The median overall survival (mOS) and clinical characteristics of AFPGC patients were analyzed. Results: Among 48 patients with AFPGC, 1 case (2.1%) in stage Ⅰ, 1 case (2.1%) in stage Ⅱ, 8 cases (16.7%) in stage Ⅲ, 36 cases (75.0%) in stage Ⅳ, and 2 cases with unknown stages; 35 cases (72.9%) received chemotherapy, 22 cases (45.8%) received local treatment, including palliative radiotherapy and hepatic artery chemoembolization, and 4 cases (8.3%) received targeted therapy. At the end of follow-up, 40 patients died, with the mOS of 16 m, 27.5 m in stage Ⅰ-Ⅲ and 14 m in stage Ⅳ, which was significantly longer than reported in the literature. Compared with non-AFPGC patients, tumor metastasis and serosal invasion of higher incidence ( 75.0% vs 38.9, x2= 22.3, p < 0.0001; 75.0% vs 38.9%, x2= 17.5, p = 0.0015 ). The incidence of liver and/or lymph node metastasis is higher (52.1% vs 17.4%, x2= 25.1, p < 0.0001; 33.3% vs 15.7%, x2= 7.7, p = 0.0054 ). The incidence of pleuroperitoneal and omental metastasis is higher (33.3% vs 11.7%, x2= 13.0, p = 0.0003 ). Conclusions: Integrated Chinese and Western Medicine can significantly prolong the survival of patients with AFPGC. AFPGC seem to be more prone to tumour metastasis, serosal invasion, liver metastasis, lymph node metastasis, pleuroperitoneal and omental metastasis. However, limited by the sample size, whether the above factors are independent prognostic factors for AFPGC is still not conclusive.