| BackgroundAlpha-fetoprotein(AFP)gastric carcinoma(AFPGC)is one of rare types of gastric cancer.Although AFPGC has been reported in previous studies.The characteristics of AFPGCs is still unclear and treatment strategies are still debatable.The purpose of this study is to provide new ideas for the treatment of AFPGC patients by analyzing the clinicopathological features,therapeutic effects and prognostic factors of AFPGC patientsMethodA retrospective analysis was performed on 3,072 patients with gastric cancer who were admitted to the second affiliated hospital of zhejiang university medical college from March 2012 to July 2019.87 patients with AFPGC who met with enrollment criteria were further analyzed in this study.A total of 88 patients with gastric cancer with normal AFP levels were randomly selected as the control group by stratified sampling method characterized by clinical staging.The mian clinicopathologic parameters were compared between AFPGC group and control group.Next,we incorporated clinical factors into univariate and multivariate cox regression analysis to determine independent prognostic factors.Survival analysis was performed using the Kaplan-Meier method and log-rank test.The efficacy of different treatments in patients with AFPGC was evaluated,and the prognostic value of AFP levels and its alteration during treatment for AFPGC was assessedResultsCompared with AFP negative gastric cancer patients,AFPGC patients had higher levels of CA211(P=0.002)and CEA(P=0.002),later clinical staging(P=0.001)and higher degree of invasion(P=0.018).AFP negative gastric cancer patients have a longer survival than AFPGC patients(mOS:32.6m vs 46.1m,P=0.032).Surgery(HR=0.340,95%CI(0.177-0.531),P<0.001),first-line chemotherapy(HR=0.306,95%CI(0.193-0.599),P<0.001),clinical staging(HR=3.681,95%CI(1.212-10.658),P=0.001)and distant metastasis(HR=2.545,95%CI(1.370-5.744),P=0.002)were independent factors for the prognosis of AFPGC patients.We also found that patients with AFPGC who underwent radical surgery tended to have longer survival(10.0m vs 26.0m,P<0.001).For patients with advanced AFPGC,chemotherapy also significantly extended their survival(mOS:14.0m vs 5m,P<0.001).After radical surgery,patients whose AFP level decreased to normal tended to have longer OS(P<0.0001),and for those patients who received chemotherapy as first-line treatment,those whose AFP level decrease>50%after chemotherapy tended to have a longer suivival(mOS:15.0m vs 7.0m,P=0.005)ConclusionAFPGC is highly invasive,with unsatisfactory efficacy and poor prognosis Radical surgery and chemotherapy can improve the survival of AFPGC patients,and the decrease of AFP level after treatment is a good indicator of AFPGC prognosis..Further research is needed to explore the optimal treatment strategy for subgroup patients. |
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