Takeyama Hiromitsu, Sawai Hirozumi, Wakasugi Takehiro, Takahashi Hiroki, Matsuo Yoichi, Ochi Nobuo, Yasuda Akira, Sato Mikinori, Okada Yuji, Funahashi Hitoshi, Akamo Yoshimi, Manabe Tadao
Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya 4678601, Japan.
World J Surg Oncol. 2007 Jul 16;5:79. doi: 10.1186/1477-7819-5-79.
Alpha-fetoprotein (AFP)-producing gastric cancer is known to frequently cause multiple liver metastases and to have an extremely poor prognosis.
A 64-year-old Japanese man admitted to our hospital was diagnosed with gastric cancer with liver metastases. He underwent a total gastrectomy with splenectomy, and pathological stage IV disease according to the classification proposed by the Japanese Gastric Cancer Association was assigned. The histological diagnosis was poorly differentiated adenocarcinoma, and tumor production of AFP was confirmed by immunohistochemical staining. Following surgery, the patient received combination chemotherapy consisting of TS-1 and paclitaxel. Initially, AFP levels decreased dramatically and computed tomography (CT) revealed regression of liver metastases. However, multiple new liver metastases appeared and serum AFP levels increased after 5 months. A regimen of 5-FU plus paclitaxel followed by paclitaxel monotherapy was used next. Serum AFP levels once again decreased and CT showed regression or disappearance of liver metastases. The patient currently has a very good quality of life, and is receiving weekly paclitaxel monotherapy as an outpatient. No progression of liver metastases has been observed to date.
We consider this rare case to have significant value with respect to treatment of AFP-producing gastric cancer with multiple liver metastases, and propose that combining surgery with chemotherapeutic agents such as paclitaxel may lead to a better prognosis in such cases.
已知产生甲胎蛋白（AFP）的胃癌常导致多发肝转移，预后极差。
一名64岁日本男性因胃癌伴肝转移入院。他接受了全胃切除术加脾切除术，根据日本胃癌协会提出的分类，被判定为病理IV期疾病。组织学诊断为低分化腺癌，免疫组化染色证实肿瘤产生AFP。术后，患者接受了由替吉奥（TS-1）和紫杉醇组成的联合化疗。最初，AFP水平显著下降，计算机断层扫描（CT）显示肝转移灶缩小。然而，5个月后出现了多个新的肝转移灶，血清AFP水平升高。接下来使用了5-氟尿嘧啶（5-FU）加紫杉醇方案，随后进行紫杉醇单药治疗。血清AFP水平再次下降，CT显示肝转移灶缩小或消失。患者目前生活质量良好，作为门诊患者接受每周一次的紫杉醇单药治疗。迄今为止，未观察到肝转移进展。
我们认为这个罕见病例对于治疗伴有多发肝转移的产生AFP的胃癌具有重要价值，并提出手术联合紫杉醇等化疗药物可能会使此类病例预后更好。
