| Research background: Gastric cancer is the fourth most common malignant tumor in the world, it is also the second common cause of the tumor-related mortality, and the mortality rate ranks third[1,2]. Alpha-fetoprotein is usually used as an effective tumor marker for primary liver cancer and genital system tumors in clinic. In addition, there have been reports of gastrointestinal cancer, pancreatic cancer, gallbladder cancer, lung cancer, breast cancer can be different degrees of elevated serum AFP levels, including gastric cancer is the most common. Bourreille et al. first reported a case of AFP producing gastric cancer with liver metastasis cases in 1970[3]. Since then, the reports of AFP production of gastric cancer is increasing, With further research and found that histological differentiation and generally have a kind of hepatocyte-like cell and carcinoma differentiation characteristics[4], which also has a high degree of malignancy, prone to liver metastasis, poor prognosis [5-7]. Whereby the AFP is becoming an independent factor for evaluating the characteristics of gastric cancer, then put forward a AFP- positive gastric cancer(AFPPGC) concept, about 1.3% to 15% of gastric cancer [8].However, it still lack sufficient understanding for AFP-positive gastric cancer and the exact pathogenesis of the disease is not clear yet, we need for continued awareness of gastric cancer from such pathology, molecular biology and genetics, and many other in-depth. AFP-positive gastric cancer have no standard treatment regimen, the treatment of gastric cancer is more common reference. Recently, a number of case reports combined cisplatin with S-1 as first-line treatment for advanced AFP-positive gastric cancer achieved significant clinical efficacy [10-13], however, lacking of large-scale clinical trials. Therefore this study retrospectively analyzed the clinical efficacy of S-1 plus cisplatin as first-line treatment in advanced AFP-positive and AFP-negative gastric cancer in our hospital.Objective: This study aimed to contrastive analysis the clinical efficacy of S-1 plus cisplatin as first-line treatment in advanced AFP-positive and AFP-negative gastric cancer.Methods: A total of 89 eligible patients with advanced gastric cancer from January 2010 to June 2013 in the First Affiliated Hospital of Zhengzhou University were enrolled in the retrospective study. The cases were divided into AFP positive group and AFP negative group, which according to the serum AFP level before treatment. The serum AFP level of 18 cases were elevated, which were incorporated into AFP positive group, however, the serum AFP level of the remaining 71 cases in the normal range,which were included in AFP negative group. Both groups received S-1 plus cisplatin as first-line treatment, comparative analysis of the clinical efficacy of the two groups.Results: There were significantly differences between AFP positive group and AFP negative group in remission rate(66.7% vs 32.4%, P=0.028) and radical surgical resection after chemotherapy rate(44.5% vs 18.3%, P=0.029). The progression free survival time between AFP positive group and AFP negative group was statistically significant(median: 7.8 months vs 5.1 months, P=0.002). The overall survival of AFP positive group was obviously longer than that of AFP negative group(median: 16.0 positive group was obviously longer than that of AFP negative group(median: 16.0 months vs 11.0 months, P=0.005). The main adverse reactions of S-1 plus cisplatin as first-line treatment between AFP positive and AFP negative group were gastrointestinal reactions and bone marrow suppression. The rate of nausea and vomiting in AFP positive group was 55.6%(10/18), accordingly the AFP negative group was 50.7%(36/71), the difference was not significant(P= 0.713). For the bone marrow suppression, the rate in the AFP positive group was 38.8%(7/18), including 1 case occurred IV myelosuppression, and the rate in the AFP negative group was 45.0%(32/71), including 5 cases of III-IV degree of bone marrow inhibition, however the difference was not statistically significant(P = 0.637).Conclusion: S-1 combined with cisplatin as first-line treatment for advanced AFP positive gastric cancer can effectively reduce the clinical stage, thus increasing the radical surgical resection rate of advanced AFP positive gastric cancer after S-1 plus cisplatin chemotherapy, And S-1 with cisplatin significantly improve the prognosis of AFP-positive gastric cancer, The progression free survival time was longer than that of AFP-negative gastric cancer, thereby significantly prolonged the overall survival of advanced AFP positive gastric cancer. |
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