Clinicopathologic Features of Gastric Cancers Producing Alpha-Fetoprotein

Abstract

Background: Patients with gastric cancers producing alpha-fetoprotein (AFP) were reported to have a poor prognosis with high rates of liver metastasis. The purpose of the present study was to clarify the clinicopathological features of AFP-producing gastric cancers, in particular characteristics of liver metastasis, and to evaluate treatment of these cancers. Methods: In 27 of the 29 cases with elevated preoperative serum AFP levels among a total of 974 primary gastric cancers, AFP production was confirmed in gastric cancer cells by immunohistochemistry. These cases were included in the AFP-positive gastric cancer group (AFP(+), 2.7%). The remaining 945 cases with normal serum AFP levels were designated the AFP-negative gastric cancer group (AFP(–)). Results: There was a higher incidence of lymph node metastasis, a deeper invasion of the gastric wall, a higher frequency of advanced stage, a more marked lymphatic invasion and a higher rate of liver metastasis in the AFP(+) group than in the AFP(–) group. The patients received curative resection in AFP(+) group had a significantly worse survival rates in comparison to that in AFP(–) group. With respect to liver metastasis (n = 17) in AFP(+) group, of 3 cases who received curative hepatic resection, 1 patient survived more than 3 years, while the remaining 2 died in less than 3 years due to multiple liver recurrence. The patients (n = 5) who received palliative resection for liver metastasis followed by transarterial continuous infusion chemotherapy all died in less than 1 year. Conclusion: AFP-producing gastric cancers had aggressive behavior and their clinical or biological features were quite different from the common AFP-negative gastric cancers. Surgical resection of liver metastasis from AFP-producing gastric cancers was unsatisfactory. The development of a novel multimodal therapy against AFP-producing gastric cancers is needed.

α-fetoprotein-producing gastric carcinoma: A case report of a rare subtype and literature review

“…The number of studies reporting this type of tumor at present is fairly small. AFP-GC is usually diagnosed in the advanced stages of disease (20)(21)(22). The prognosis of AFP-GC is closely associated with the tumor stage (20,30).…”

“…AFP-GC may be divided into two subtypes, consisting of AFP-producing non-hepatoid adenocarcinoma and hepatoid adenocarcinoma. AFP-GC is usually diagnosed in the advanced stages of disease and demonstrates a poor prognosis (20)(21)(22). In patients exhibiting serum AFP levels of >300 ng/ml, the 1-, 3-, and 5-year survival rates are 15.4, 7.7%, and 0%, respectively.…”

Gastric choriocarcinoma admixed with an α-fetoprotein-producing adenocarcinoma and separated adenocarcinoma

“…The clinical implications of the three subtypes have not been evaluated, although the bestcharacterized hepatoid type, which is the most common, is known to have a high malignant potential and to be associated with poor survival [15] . The prognosis of PGC is poor because of its high metastatic potential, especially to the liver, lung and regional lymph nodes, and most PGC patients succumb within a year of operation.…”

A Case of Gastric Undifferentiated Carcinoma with Focal Yolk Sac Tumor and Hepatoid Carcinoma Differentiation

“…AFP 을 분비하는 경우는 진단 당시 약 63%에서 이미 간전이가 되 어 있을 정도로 조기 간전이율이 높으며, 5년 생존율이 약 28% 로 분비하지 않는 위암의 평균 생존율 62%보다 예후가 나쁘다 고 알려져 있다. 10 위 미분화암에 난황낭 암종과 간세포양암종이 공존하는 경우 …”