Novelcharacteristics Of Alpha-fetoprotein (AFP)-producing Gastric Cancer

Background:Although serum AFP level is increased in the AFP-producing gastric cancer(AFPGC)patient,the AFP-GC may also recur without further increasing the serum AFP level.Therefore,it is necessary to explore the new features of AFP-GC,such as other biomarkers.Methods:Retrospective analysis was carried out for 3260 inpatients of gastric cancer from January 2012 to July 2017 in the Second Affiliated Hospital of Zhejiang University School of Medicine who were diagnosed by histology.Of them,We found fifty-five cases of AFP-GC patients at the age of 65.0±11.3(range 34-84)and their average serum AFP level was 839.4 ±1979.0 ng/mL.Then,We randomly selected the same quatity of non-AFP-GC patients at the age of 61.62±10.4(range 31-81)in the second affiliated Hospital of Zhejiang University as the control group,and their average serum AFP level was 2.9 ± 1.6 ng/mL.Results:Our present study firstly revealed that blood type O(20 cases:14 cases)and A(18 cases:20 cases)positive were predominantly observed among AFP-GC and non-AFP-GC patients,respectively.Intriguingly,the least consistently was blood type AB-positive(4 cases:7 cases).Pre-operative serum AFP levels were weakly and reversely associated with pre-operative percentage of lymphocytes in the peripheral blood(R2=0.091,Pearson's correlation =0.302*).Nevertheless,anemia and elevated levels of serum CEA,CA125 were observed among 67.9%(36/53),56.6%(30/53),18.9%(10/53)of AFP-producing GC patients.Furthermore,it was interestingly found that the level of alkaline phosphatase(ALP)was moderately correlated with the level of lactate dehydrogenase(LDH)(R2=0.310,Pearson's correlation =0.773**)and CEA(R2=0.597,Pearson's correlation =0.773**).The level of CEA was weakly correlated with the level of LDH(R2=0.100,Pearson's correlation=0.315*).By contrast,no any associations between ALP,LDH,CEA,AFP,and peripheral lymphocytes were observed among those 53 non-AFP-GC patients.Finally,we found that the liver metastasis rate in the AFP ?23.2ng/mL group was significantly higher than that in the AFP<23.2ng/mL group(P<0.01),which was 20.4 times higher than that in the AFP<23.2ng/mL group.Interestingly,compared with AFPGC with AFP<300ng/ml,there was no significant difference in liver metastasis rate in patients with serum AFP level ? 300 ng/mL and 10/19 patients with 52.6%of the patients successfully received radical gastrectomy in accordance with their clinical stages(p>0.05).Conclusion:The aggressive biological features of AFP-producing GC are closely associated with abnormality of other tumor biomarkers and decrease of the proportion of peripheral lymphocytes,implying that post-operative increase of peripheral lymphocytes might benefit GC patients.Combined use of multiple biomarkers is of significance in comprehensive evaluation of AFP-producing GC patients and assessment for those with high risk of cancer recurrence.The high level of serum AFP(? 300ng/mL)in AFP gastric cancer may affect the prognosis,but the liver metastasis rate is not significant.