Predictive and prognostic value of serum AFP level and its dynamic changes in advanced gastric cancer patients with elevated serum AFP

Abstract

AIMTo investigate predictive and prognostic value of serum alpha-fetoprotein (AFP) level and its dynamic changes in patients with advanced gastric cancer with elevated serum AFP (AFPAGC).METHODSOne hundred and five patients with AFPAGC were enrolled in the study, and all of them underwent at least one cycle of systemic chemotherapy at our institute and had serum AFP ≥ 20 ng/mL at diagnosis or recurrence. Clinicopathologic features, serum AFP level at diagnosis and changes during treatment, first-line chemotherapy regimens, efficacy and toxicity, and survival information were collected. A Person’s χ2 or Fisher’s exact test was used to measure the differences between variables. Survival prognostic factors were investigated using the Kaplan-Meier method and Cox regression.RESULTSMedian serum AFP level was 161.7 ng/mL (range, 22.9-2557110 ng/mL). Objective response rates (ORR) was significantly lower in the AFP ≥ 160 ng/mL group than in the AFP < 160 ng/mL group (30.4% vs 68.3%, P < 0.001). ORR to doublet regimens was significantly lower in the AFP ≥ 160 ng/mL group, whereas ORR to triplet regimens was similar between the two groups. Liver metastasis rate was significantly higher in the AFP ≥ 160 ng/mL group than in the AFP < 160 ng/mL (69.8% vs 50.0%, P < 0.001). Overall survival (OS) in the two cohorts did not show any significant difference (P = 0.712). Dynamic changes of AFP were consistent with response to chemotherapy, and median OS of patients with a serum AFP decline ≥ 50% and those with a serum AFP decline < 50% was 17.5 m and 10.0 m, respectively (P = 0.003). Hepatic (P = 0.005), peritoneal (P < 0.001), non-regional lymph node metastasis (P < 0.001), and portal vein tumor thrombus (PVTT) (P = 0.042) were identified as independent prognostic factors for AFPAGC.CONCLUSIONReal-time examination of AFP has great predictive and prognostic value for managing AFPAGC. For those with markedly elevated AFP, triplet regimens may be a better choice.

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

“…[ 27 ] In the present study, LM was present in 39.6% of the 96 patients with AFPGC. According to the NCCN Clinical Practice Guidelines in Oncology: GC, [ 20 ] LM of GC should be directly classified as stage IV, which is associated with poor prognosis, [ 28 ] as confirmed in the present study. It is recommended that for patients with operable GC, radical gastrectomy is the preferred treatment.…”

“…[ 22 – 24 ] Recently, Wang et al suggest that triplet chemotherapy regimens may be a better choice for GC patients with markedly elevated AFP. [ 20 ] The present study compared 4 general chemotherapy regimens, including monotherapy, docetaxel-cis-platinum-fluorouracil acid, FOLFOX, and oxaliplatin-xeloda (capecitabine), with palliative therapy, in terms of OS and PFS, and demonstrated that compared with palliative treatment, there was no significant difference in the OS and PFS between the 4 chemotherapy regimens ( P > 0.05).…”

“…Moreover, we further observed that a greater than 50% decline in serum AFP level during the treatment was associated with greater survival benefits, which was consistent with the findings obtained in a previous study in which Wang et al enrolled GC patients with serum AFP ≥ 20 ng/mL at diagnosis or recurrence and observed that a serum AFP decline ≥ 50% during the treatment was associated with an increased median OS. [ 20 ] Thus, continued monitoring the serum AFP levels could predict the efficacy of a treatment for an individual patient with AFPGC and provide information for modification of the treatment plan for the particular patient.…”

“…At present, there is no particular recommendation for chemotherapy for AFPGC treatment in the NCCN Clinical Practice Guidelines in Oncology: GC, [ 20 ] and determination of the effective treatment plan for AFPGC remains in the exploration stage. Some studies have found that regimens with apatinib or gimeracil and oteracil potassium plus cisplatin are helpful in improving the prognosis of AFPGC.…”

<p>Effect of Immune Checkpoint Inhibitors Plus Chemotherapy on Advanced Gastric Cancer Patients with Elevated Serum AFP or Hepatoid Adenocarcinoma</p>

“…Intensive treatment (triplet regimen) seems to have slightly better disease control rate with 13.9 months of median OS. 25 …”