Clinical Significance Of Increased AFP Before Surgery For Gastric Cancer In Postoperative Prognosis And Occurrence Of Liver Metastasis

Objective: AFP positive gastric cancer(Alpha-fetoprotein Producing Gastric Cancer,AFPGC)is a rare type of gastric cancer,and its clinical and biological characteristics are different from ordinary gastric cancer.This study explored the clinical significance of preoperative AFP increase in gastric cancer in the postoperative prognosis and liver metastasis.Methods: From November 1,2012 to November 1,2017,954 patients with gastric cancer who underwent surgical treatment in the Affiliated Hospital of Qinghai University were collected.48 cases with elevated AFP before operation(serum AFP value> 10ng)were included in the experimental group,and 48 cases with normal AFP value were randomly included as the control group by the stratified sampling method characterized by clinical staging.The clinical characteristics(gender,age,maximum tumor diameter,tumor location,gross classification,TNM staging,operation method,chemotherapy before and after operation,etc.),pathological characteristics(degree of differentiation,nerve infiltration,vascular infiltration,etc.)of the two groups of cases)To describe,and then compare the two sets of data.Describe the survival and prognosis of the two groups(postoperative liver metastasis,3-year OS and PFS).This study focuses on the relationship between preoperative AFP levels and postoperative prognosis(postoperative liver metastasis,3-year OS and PFS).For the preoperative AFP value of AFP-positive gastric cancer patients,it is explored whether there is a cutoff value that affects the prognosis(postoperative liver metastasis).The measurement data were compared by t test,and the count data was compared by chi-square test.After drawing the Kaplan-Meier survival curve,the Log-Rank method was used to compare whether there is a difference between the two groups,and the correlation between whether the AFP increased before operation and whether liver metastasis occurred after operation The Spearman test was used to analyze the prognostic factors of the preoperative AFP increase group using Kaplan-Meier.The two data of preoperative serum AFP value and whether there was liver metastasis after operation were used to make ROC curve to calculate the cutoff value.Where p<0.05,the difference is considered to be statistically significant.Results: 1.The preoperative AFP elevated group and the preoperative AFP normal group were in terms of gender,age,maximum tumor diameter,tumor location,gross classification,TNM classification,surgical methods,and whether there was chemotherapy before and after surgery.There is no significant difference.2.Based on the postoperative pathology of the patient,it is divided into five types: poorly differentiated,moderately poorly differentiated,moderately differentiated,moderately poorly differentiated,and poorly differentiated,and counts whether nerve and vascular infiltration are found.There was no significant difference between the preoperative AFP elevated group and the preoperative AFP normal group in terms of differentiation and nerve infiltration,but there were significant differences in vascular infiltration(p<0.05).3.The 3-year overall survival rate(OS)of the preoperative elevated AFP group was lower than that of the preoperative normal AFP group,(p <0.05);the 3-year disease-free survival rate(PFS)of the preoperative elevated AFP group was lower than that of the surgical The former AFP normal group,(p<0.05).4.The kaplan-meier method was used to analyze the prognostic factors of 48 patients with elevated AFP before operation.The results suggest that the degree of tumor differentiation is a risk factor affecting the prognosis of gastric cancer with elevated AFP.5.Spearman correlation analysis between preoperative AFP increase and postoperative liver metastasis,p<0.05,correlation coefficient is 0.235,that is,preoperative AFP increase is significantly correlated with postoperative liver metastasis,and it is positively correlated.6.The experimental group and the control group,using the preoperative serum AFP value of all cases and whether there is liver metastasis after the operation,are used to make the ROC curve to calculate the cutoff value.The cut-off value of serum AFP affecting postoperative liver metastasis was 22.43ng/ml.Conclusions: 1.Gastric cancer with elevated AFP before operation has no significant difference in clinical features from gastric cancer with normal AFP.2.In terms of pathological characteristics,preoperative gastric cancer with elevated AFP is more likely to have vascular infiltration and stronger invasion ability.3.The 3-year overall survival rate(OS)and disease-free survival rate(PFS)of gastric cancer with elevated AFP before surgery are lower than those of gastric cancer with normal AFP.The prognosis of gastric cancer with elevated AFP before surgery is worse.4.The degree of differentiation has a significant impact on the prognosis of gastric cancer with elevated AFP and normal AFP before surgery.5.Gastric cancer with elevated AFP before surgery is more likely to have liver metastasis after surgery.6.The cut-off value of this study is 22.43ng/ml,which has certain clinical significance for determining the serum AFP value of gastric cancer with elevated AFP before operation.