Reim D, Choi Y-S, Yoon H M, Park B, Eom B W, Kook M-C, Ryu K W, Choi I J, Joo J, Kim Y-W
Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Ilsan-ro 323, Ilsandong-gu, Goyang-si Gyeonggi-do, 410-769, Republic of Korea; Klinikum Rechts der Isar der Technischen Universität München, Department of Surgery, Ismaninger Strasse 22, 81675 Munich, Germany.
Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Ilsan-ro 323, Ilsandong-gu, Goyang-si Gyeonggi-do, 410-769, Republic of Korea.
Eur J Surg Oncol. 2017 Aug;43(8):1542-1549. doi: 10.1016/j.ejso.2017.04.005. Epub 2017 May 3.
Prognosis of alpha-fetoprotein positive gastric cancer (AFPP-GC) remains elusive so far due to disparities in cohort size and baseline characteristics in previous studies. A propensity score matching (PSM) analysis as well as multivariable model was performed for unbiased evaluation of the outcome in AFPGC.
Among 3034 gastric cancer patients who underwent curative gastric cancer surgery (R0, M0) at the National Cancer Center, Korea between 2002 and 2007, we identified 97 patients being positive for AFP either by elevation of serum-AFP levels >10 μg/L or by immunohistochemical staining. Due to marked disparities in baseline characteristics and cohort size, propensity-score-matching was performed which matched 87 AFPP-GC patients to the same number of AFP-negative gastric cancer (AFPN-GC) patients. Baseline characteristics were compared using χ-test. Survival curves were compared using the Kaplan-Meier-method and multivariable regression analysis was performed to evaluate the effect of AFP-positivity while adjusting the effects of confounding variables.
AFPP-GC and AFPN-GC patients revealed marked disparities in patient cohorts. After PSM, groups were balanced for age, sex, tumor size, BMI, tumor location, grade of differentiation, presence of lymphatic vessel infiltration (LVI), Lauren histologic type and stage distribution. In multivariable regression analysis of the PSM-groups, only AFP-positivity and pathologic stage were predictive for overall survival (HR 2.98, CI 95% {1.7-5.1}, p < 0.0001). Five-year-survival rates were significantly worse for AFPP-GC patients (57.9% vs. 76.1%, p = 0.014). Recurrence was significantly more frequent in AFPP-GC patients (p = 0.003).
AFP can be considered as an independent negative predictor of overall and recurrence-free survival in patients with gastric cancer.
由于既往研究中样本量和基线特征存在差异，甲胎蛋白阳性胃癌（AFPP-GC）的预后至今仍不明确。进行了倾向评分匹配（PSM）分析以及多变量模型分析，以对AFPGC的预后进行无偏评估。
在2002年至2007年间于韩国国立癌症中心接受胃癌根治性手术（R0，M0）的3034例胃癌患者中，我们确定了97例甲胎蛋白阳性患者，这些患者血清甲胎蛋白水平升高>10μg/L或经免疫组化染色呈阳性。由于基线特征和样本量存在显著差异，进行了倾向评分匹配，将87例AFPP-GC患者与相同数量的甲胎蛋白阴性胃癌（AFPN-GC）患者进行匹配。使用χ检验比较基线特征。使用Kaplan-Meier法比较生存曲线，并进行多变量回归分析，以评估甲胎蛋白阳性的影响，同时调整混杂变量的影响。
AFPP-GC和AFPN-GC患者在患者队列中存在显著差异。PSM后，两组在年龄、性别、肿瘤大小、BMI、肿瘤位置、分化程度、淋巴管浸润（LVI）、Lauren组织学类型和分期分布方面达到平衡。在PSM组的多变量回归分析中，只有甲胎蛋白阳性和病理分期可预测总生存期（HR 2.98，CI 95%{1.7-5.1}，p<0.0001）。AFPP-GC患者的5年生存率显著更差（57.9%对76.1%，p=0.014）。AFPP-GC患者的复发明显更频繁（p=0.003）。
甲胎蛋白可被视为胃癌患者总生存期和无复发生存期的独立负性预测指标。
