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
ARTICLE HIGHLIGHTS
Research background

Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is a special subgroup of gastric cancer (GC), and there are robust data confirming the poor prognosis for this population, especially for those with resected disease. However, due to aggressive biological behavior and high frequency of liver metastasis, most AFPGC patients were considered as inoperable at the initial diagnosis and there is limited data in the literature about management of AFP- producing advanced GC.

Research motivation

As the precise underlying mechanism of AFPGC remains to be elucidated, the optimal treatment approach requires further consideration, especially for advanced gastric cancer with elevated serum AFP (AFPAGC). Therefore, we performed this study to seek better management regimen for AFPAGC, with an aim to improve the prognosis of this special aggressive cancer.

Research objectives

The main objectives of this study were: (1) to elucidate predictive and prognostic value of serum AFP level and its dynamic changes during management of AFPAGC; and (2) to discover optimal treatment modality for AFPAGC. This would also allow risk stratification for patients with gastric cancer in future clinical trials.

Research methods

Patient data in this study were obtained by reviewing electronic medical charts. Statistical analyses were performed with SPSS 21.0 software. A Person’s χ2 test was used to measure the differences among variables. To identify prognostic factors for APFAGC, survival durations were calculated using the Kaplan-Meier method and Cox regression.

Research results

Our results revealed that for AFPAGC, serum AFP level was associated with liver metastasis rate and response to chemotherapy. Serum AFP decline degree was associated with response to chemotherapy and survival. Furthermore, we investigated optimal chemotherapy regimen for this special population, which revealed that for those with marked AFP elevation, triplet regimens could offer a better objective response rates (ORR) than doublet regimens, but the toxicity is a problem that remains to be solved. Finally, hepatic (P = 0.005), peritoneal (P < 0.001), non-regional lymph node metastasis (P < 0.001), and PVTT (P = 0.042) were identified as independent prognostic factors for AFPAGC.

Research conclusions

This is the first study to elucidate the great predictive and prognostic value of real-time examination of serum AFP in managing AFPAGC. We also suggest that for GCs with markedly elevated AFP, triplet regimens may be a better choice. This would also allow risk stratification for patients with gastric cancer in future clinical trials.

Research perspectives

Since AFPAGC is rare, for which large prospective clinical trials are not feasible, it is very significant to summarize clinical experience retrospectively. Although our results showed that triplet regimens may offer a better ORR, there remains controversy regarding the utility of triplet regimens due to their toxicity. Therefore, it will be necessary to optimize triplet regimens and find new therapeutic targets in future studies. Next generation sequencing may bring us new insight in the future.