Wang Ruhan, Li Jing, Xu Dan, Li Ruiyang, Gong Ping
Department of Oncology, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi City.
Department of Oncology, The Affiliated Hospital of Hubei University of Arts and Sciences, Xiangyang Central Hospital, The People's Republic of China.
Medicine (Baltimore). 2020 Nov 20;99(47):e23326. doi: 10.1097/MD.0000000000023326.
Alpha-fetoprotein (AFP)-producing gastric cancer (AFPGC) is rare and associated with a suboptimal prognosis. The aim of this retrospective study was to identify prognostic factors, with a particular focus on the dynamics of serum AFP levels during treatment, in AFPGC patients.Data of patients with pathologically diagnosed primary gastric cancer treated with various modalities electronically collected in the medical management systems of 2 hospitals (ie, Shihezi People's Hospital and Shihezi Hospital) in Shihezi city, northwest China, from January 2007 to October 2018 were reviewed. Patients with AFPGC were identified based on serum AFP levels. Associations of the change in serum AFP levels and clinicopathological parameters with treatment response, including the overall response rate and disease control rate, and outcomes, including overall survival (OS) and progression-free survival (PFS), were compared among different groups.Of 2354 patients diagnosed with gastric cancer, 96 patients with AFPGC were identified. The objective response rate and disease control rate were significantly higher in patients whose AFP level decreased by ≥50% than in patients whose AFP level decreased by <50% (68.8% vs. 40.6%, and 87.5% vs. 53.1%, respectively, both P < .05). The median OS and PFS were 32.0 (4-74) and 24.0 (1-66) months, respectively, in patients with a ≥50% decline in AFP, and 12.5 (0-69) and 9.0 (0-63) months, respectively, in those with a <50% decline in AFP (both P < .05). On univariate and multivariate analyses, tumor, node, metastasis staging classification stage, liver metastasis, curable surgery, and the decline in the serum AFP level were associated with OS and PFS.A significant decline in the serum AFP level was associated with good treatment response and prognosis in AFPGC. Along with a decline in the serum AFP level, tumor, node, metastasis staging classification stage, liver metastasis, and curable surgery were also independent factors associated with prognosis.
产生甲胎蛋白（AFP）的胃癌（AFPGC）较为罕见，且预后欠佳。本回顾性研究旨在确定AFPGC患者的预后因素，尤其关注治疗期间血清AFP水平的动态变化。回顾了2007年1月至2018年10月在中国西北部石河子市的2家医院（即石河子市人民医院和石河子医院）的医疗管理系统中以电子方式收集的接受各种治疗方式的原发性胃癌病理诊断患者的数据。根据血清AFP水平确定AFPGC患者。比较了不同组中血清AFP水平变化和临床病理参数与治疗反应（包括总缓解率和疾病控制率）以及预后（包括总生存期（OS）和无进展生存期（PFS））之间的关联。在2354例诊断为胃癌的患者中，确定了96例AFPGC患者。AFP水平下降≥50%的患者的客观缓解率和疾病控制率显著高于AFP水平下降<50%的患者（分别为68.8%对40.6%，87.5%对53.1%，P均<0.05）。AFP下降≥50%的患者的中位OS和PFS分别为32.0（4 - 74）个月和24.0（1 - 66）个月，而AFP下降<50%的患者分别为12.5（0 - 69）个月和9.0（0 - 63）个月（P均<0.05）。单因素和多因素分析显示，肿瘤、淋巴结、转移分期分类阶段、肝转移、可根治性手术以及血清AFP水平下降与OS和PFS相关。血清AFP水平显著下降与AFPGC的良好治疗反应和预后相关。随着血清AFP水平下降，肿瘤、淋巴结、转移分期分类阶段、肝转移和可根治性手术也是与预后相关的独立因素。
