Influence of high serum alpha fetoprotein on patients with gastric cancer

Backgrounds: Patients with alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) have a high incidence of liver metastasis and poor prognosis. However, the clinical manifestation of AFPGC remains controversial. Methods: We enrolled patients who, before surgery, had gastric cancer with serum AFP levels of ＞100 ng/mL (n ＝ 30) and of ≦ 20 ng/mL (n ＝ 1236). Clinical manifestations were compared between these two groups. Results: Compared with in the AFP ＞ 100 group, early gastric cancer was more frequent (30.1% vs.0%) and advanced gastric cancer was less frequent (69.9% vs. 100%) in the AFP ≦ 20 ng/mL group (p ＜ 0.001). Moreover, the incidence of liver and lymph node metastases was lower in the AFP ≦ 20 ng/mL group than in the AFP ＞ 100 ng/mL group (4.4% vs. 43.3%, p ＜ 0.001 and 60.7% vs. 93.3%,p ＜ 0.001, respectively). More patients had stage IV AFPGC in the AFP ＞ 100 ng/mL group than in the ≦ 20 ng/mL group (66.7% vs 27.1%, p ＜ 0.001). Furthermore, fewer patients underwent curative surgery in the AFP ＞ 100 ng/mL group (6.7% vs 37.9%, p ＜ 0.001). More patients in the AFP ＞ 100 ng/mL group died because of gastric cancer (66.7% vs 27.1%, p ＜0.0001).Conclusions: Patients with very high serum AFP levels have a high incidence of liver and lymph node metastases and extremely poor prognosis.