Dynamic Change in Serum Alpha-fetoprotein Level Predicts Treatment Response and Prognosis of Alpha-fetoprotein-producing Gastric Cancer

Abstract

Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is rare and associated with a suboptimal prognosis. The aim of this retrospective study was to identify prognostic factors, with a particular focus on the dynamics of serum AFP levels during treatment, in AFPGC patients. Data of patients with pathologically diagnosed primary gastric cancer treated with various modalities electronically collected in the medical management systems of 2 hospitals (ie, Shihezi People's Hospital and Shihezi Hospital) in Shihezi city, northwest China, from January 2007 to October 2018 were reviewed. Patients with AFPGC were identified based on serum AFP levels. Associations of the change in serum AFP levels and clinicopathological parameters with treatment response, including the overall response rate and disease control rate, and outcomes, including overall survival (OS) and progression-free survival (PFS), were compared among different groups. Of 2354 patients diagnosed with gastric cancer, 96 patients with AFPGC were identified. The objective response rate and disease control rate were significantly higher in patients whose AFP level decreased by ≥50% than in patients whose AFP level decreased by <50% (68.8% vs. 40.6%, and 87.5% vs. 53.1%, respectively, both P < .05). The median OS and PFS were 32.0 (4-74) and 24.0 (1-66) months, respectively, in patients with a ≥50% decline in AFP, and 12.5 (0-69) and 9.0 (0-63) months, respectively, in those with a <50% decline in AFP (both P < .05). On univariate and multivariate analyses, tumor, node, metastasis staging classification stage, liver metastasis, curable surgery, and the decline in the serum AFP level were associated with OS and PFS. A significant decline in the serum AFP level was associated with good treatment response and prognosis in AFPGC. Along with a decline in the serum AFP level, tumor, node, metastasis staging classification stage, liver metastasis, and curable surgery were also independent factors associated with prognosis.

Alpha‑fetoprotein can promote gastric cancer progression via upregulation of metastasis‑associated colon cancer 1

“…To the best of our knowledge, the present study was the first to reveal that AFP could upregulate MACC1 activity and thus promote GC proliferation, migration, and invasion. Numerous previous studies reported that high expression levels of AFP and MACC1 are significantly associated with higher metastasis and poor prognosis in GC, respectively (8,9,14,15,24,25). The findings from the present study demonstrated that AFP could enhance tumor progression rather than acting as a tumor marker.…”

“…Serum AFP level is a prognostic factor for overall survival and treatment response in patients with AFP-GC (24,25). In common GC, a higher serum AFP level is also an independent factor of poor prognosis (8,9).…”

Combinational zimberelimab plus lenvatinib and chemotherapy for alpha-fetoprotein elevated, advanced gastric cancer patients (AFPGC): a phase 1 dose-escalation study

“…Considering the distinct feature of AFPGC from typical adenocarcinoma, serum AFP level was expected to be correlated with malignant degree and prognosis. However, controversary results exist in previous investigations [ 28 , 29 ]. In our study, we did not observe definite correlation between serum AFP level and tumor burden at diagnosis.…”

Potentiality of α-fetoprotein (AFP) and soluble intercellular adhesion molecule-1 (sICAM-1) in prognosis prediction and immunotherapy response for patients with hepatocellular carcinoma

“…However, the study of Shimura et al showed HCC patients with sICAM-1 ≥ 440 ng/ml exhibited a poorer OS and recurrence-free survival than those with sICAM-1 < 440 ng/ml (P = 0.002) [ 27 ]. Besides, a study in gastric cancer showed that the median OS and progression-free survival in patients whose AFP level decreased by ≥ 50% were respectively 32.0 (4–74) and 24.0 (1–66) months, and which in patients whose AFP level decreased by < 50% were respectively 12.5 (0–69) and 9.0 (0–63) months [ 28 ]. These results suggested that, although the cutoff values of AFP and sICAM-1 levels were inconsistent which might be due to the small sample volume, the higher AFP and sICAM-1 levels were closely associated with a poorer prognosis of patients.…”