Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 14, 2018; 24(2): 266-273
Published online Jan 14, 2018. doi: 10.3748/wjg.v24.i2.266
Predictive and prognostic value of serum AFP level and its dynamic changes in advanced gastric cancer patients with elevated serum AFP
Ya-Kun Wang, Lin Shen, Xi Jiao, Xiao-Tian Zhang
Ya-Kun Wang, Lin Shen, Xi Jiao, Xiao-Tian Zhang, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China
Author contributions: Wang KY collected and analyzed the data and wrote the manuscript; Jiao X collected the data and revised the manuscript; Shen L and Zhang XT were in charge of the project and revised the manuscript.
Supported by the National Key Research and Development Program of China, No. 2017YFC1308900; Beijing Natural Science Foundation, No. 7161002; and Capital Health Improvement and Research Funds, No. 2016-1-1021.
Institutional review board statement: This study was approved by the Ethics Committee of Beijing University Cancer Hospital.
Informed consent statement: Patients were not required to give informed consent for this study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors has declared any conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Tian Zhang, MD, Professor, Department of Gastrointestinal Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, No. 52, Fucheng Road, Haidian District, Beijing 100142, China. zhangxiaotianmed@163.com
Telephone: +86-10-88196561 Fax: +86-10-88196561
Received: October 26, 2017
Peer-review started: October 27, 2017
First decision: November 14, 2017
Revised: November 18, 2017
Accepted: December 5, 2017
Article in press: December 5, 2017
Published online: January 14, 2018
Abstract
AIM

To 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).

METHODS

One 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.

RESULTS

Median 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.

CONCLUSION

Real-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.

Keywords: Alpha-fetoprotein, AFP-producing gastric cancer, Predictive factor, Prognostic factor, Triplet regimen

Core tip: Alpha-fetoprotein (AFP)-producing gastric cancer is a rare and aggressive subtype of gastric cancer, characterized by frequent liver metastasis and poor prognosis. We measured AFP and its changes over time during treatment, which revealed that AFP, as a biomarker of advanced gastric cancer with elevated serum AFP (AFPAGC), is significantly associated with response to chemotherapy. The decline in AFP after chemotherapy was found to be related to good prognosis for AFPAGC. We finally attempted to find an optimal treatment regimen for AFPAGC, which suggests that for those with markedly elevated AFP, triplet regimens may be a better choice.