| Objective:Alpha-fetoprotein-producing gastric cancer is different from normal gastric carcinoma.It is rare in clinic,which has high malignant degree,lymphatic invasion,vascular invasion,liver metastasis and poor prognosis.At present,there is still a lack of alpha-fetoprotein-producing gastric cancer in a large study reported in the literature.Further more,controversy exists about clinicopathological characteristics and prognosis of this disease.In this retrospective study,we reviewed the clinicopathologic findings of 30 patients with pathologically confirmed and serum AFP positive gastric cancer in the Affiliated Tumor Hospital of Guangxi Medical University.Then we analyzed its clinicopathological characteristics and prognosis of this disease,so as to provide reference for this disease about clinical diagnosis and treatment.Methods:A total of 257 cases of gastric cancer in Affiliated Tumor Hospital of Guangxi Medical University from January 2005 to May 2010 were retrospectively reviewe.Patients were divided into two groups:30 serum AFP-positive patients (AFPGC group) and 227 serum AFP-negative patients (non-AFPGC group).Record the two groups of patients’ gender,age,serum pre-treatment AFP level,serum pre-treatment CEA level,serum postoperative AFP level,curative surgery,ways of surgical resection,the extent of lymph nodes dissection,tumor location,tumor size,cross type,depth of invasion,histological type,degree of differentiation,vascular invasion,perineural invasion,lymph node involvement,clinical stage,liver metastasis and number of liver metastasis,interval of metachronous metastasis,treatment of liver metastasis,extrahepatic metastasis and patients were followed up and analysisof the clinicopathological characteristics and prognostic factors.Results:(1)There were 30 AFP-producing gastric carcinoma which accounting for 11.7% of 257 gastric cancer of the corresponding time period.There was more frequent of serosal invasion(60.0% vs 32.6%),vascular invasion(76.7% vs 52.4%),perineural invasion(76.7% vs 54.2%),deeper invasion,later clinical stage,lymph node involvement(66.6%vs 41.0%),liver metastasis(53.3% vs 15.4%),extrahepatic metastases(43.3% vs 25.6%) in the AFP-positive group than in the AFP-negative group,with a statistically significant difference(P<0.05).(2)Pre-treatment AFP level of AFPGC group was divided into two stages:>100ng/ml(n=11) and 20～100ng/ml(n=19).The number of liver metastasis in AFPGC group was also classified into two groups:multiple(n=11) and single or double(n=5).The results showed that the rate of liver metastasis for patients in AFP>100ng/ml stage was higher than patients in AFP with 20～ 100ng/ml stage(62.5% vs 37.5%,p=0.002).What is more, the rate of multiple liver metastasis for patients in AFP>100ng/ml stage was also significantly higher than patients in AFP with 20～100ng/ml stage(81.8% vs 18.2%,p=0.018).However,the rate of lymph node metastasis for patients in AFP>100ng/ml stage was less than patients in AFP with 20～100ng/ml stage(45.0% vs 55.0%,p=0.217),without a statistically significant difference.(3)AFPGC group had a poorer prognosis than non-AFPGC group.Thel-,3-,5-year survival rates for patients in AFPGC group were 60.0%,46.7%,30.0% respectively.However,the 1-,3-,5-year survival rates for non-AFPGC group were 77.1%,66.5%,60.8% respectively.Multivariate COX analysis revealed that age and serum pre-treatment AFP level were independent prongostic factors of alpha-fetoprotein-producing gastric cancer.Conclusion:(1)Alpha-fetoprotein-producing gastric cancer is different from normal gastric carcinoma.lt has a high degree of malignancy and is usually later in clinical stage.lt is easier to occur vascular invasion and metastasize to lymph nodes or liver.(2)There is a positive correlation between pre-treatment AFP level,liver metastasis and number of liver metastasis.However,pre-treatment AFP level has no relationship with lymph node metastasis.(3)Alpha-fetoprotein-producing gastric cancer has a poor prognosis.The independent prognostic factors of alpha-fetoprotein-producing gastric cancer are age and serum pre-treatment AFP level. |
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