Zuo Fei, Tan Yunyan, Mao Wenjun, Tang Zhaoqing, Luo Tianping
Department of General Surgery, Changzhou Traditional Chinese Medicine Hospital, Affiliated Hospital of Nanjing University of Chinese Medicine, Changzhou, China.
Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
Front Oncol. 2025 May 23;15:1598337. doi: 10.3389/fonc.2025.1598337. eCollection 2025.
BACKGROUND: Alpha-fetoprotein (AFP) is an established biomarker for liver cancer, but its role in gastric cancer (GC) remains unclear. This study evaluated AFP's prognostic value in GC and developed a survival prediction model incorporating AFP and other clinical factors. METHODS: We analyzed 766 GC patients from Changzhou Traditional Chinese Medicine Hospital, categorizing them as AFP-positive (>20 ng/mL) or AFP-negative (≤20 ng/mL). Kaplan-Meier and Cox regression analyses assessed the association between AFP levels and overall survival (OS). A nomogram based on identified prognostic factors was created and evaluated using ROC curves, calibration curves, and decision curve analysis (DCA). RESULTS: Among 766 gastric cancer (GC) patients, 3.3% (n=25) exhibited elevated AFP levels (>20 ng/mL). The AFP-positive group demonstrated significantly more aggressive clinicopathological features, including larger tumor size ( < 0.05), deeper invasion (higher T-stage), increased lymph node metastasis (higher N-stage), and higher rates of distant metastasis ( = 0.035). Survival analysis revealed markedly worse outcomes for AFP-positive patients (Log-rank < 0.001), with a 68% higher mortality risk (unadjusted HR =1.68, 95% CI: 1.27-2.23). Multivariate Cox regression confirmed AFP positivity as an independent prognostic factor (adjusted HR = 1.8, 95% CI: 1.03-3.14, =0.04), alongside T4-stage, N3-stage, and distant metastasis. A prognostic nomogram integrating AFP levels and TNM staging achieved superior predictive accuracy (AUCs: 0.80-0.84) compared to TNM staging alone (AUCs: 0.70-0.74) across 1-, 3-, and 5-year survival. Calibration and decision curve analyses further validated the model's clinical utility, supporting its role in risk stratification and treatment planning. CONCLUSIONS: AFP is a significant independent prognostic factor in gastric cancer, and its inclusion in a multivariate model enhances survival prediction. The prognostic nomogram developed in this study offers clinicians a valuable tool for predicting patient outcomes and guiding treatment decisions. Further validation and prospective studies are necessary to confirm the model's clinical applicability.
背景：甲胎蛋白（AFP）是一种公认的肝癌生物标志物，但其在胃癌（GC）中的作用仍不明确。本研究评估了AFP在胃癌中的预后价值，并建立了一个纳入AFP和其他临床因素的生存预测模型。 方法：我们分析了常州市中医医院的766例胃癌患者，将其分为AFP阳性（>20 ng/mL）或AFP阴性（≤20 ng/mL）。采用Kaplan-Meier法和Cox回归分析评估AFP水平与总生存期（OS）之间的关联。基于确定的预后因素创建了一个列线图，并使用ROC曲线、校准曲线和决策曲线分析（DCA）进行评估。 结果：在766例胃癌患者中，3.3%（n = 25）的患者AFP水平升高（>20 ng/mL）。AFP阳性组表现出明显更具侵袭性的临床病理特征，包括更大的肿瘤大小（<0.05）、更深的浸润（更高的T分期）、更高的淋巴结转移率（更高的N分期）以及更高的远处转移率（=0.035）。生存分析显示，AFP阳性患者的预后明显更差（对数秩检验<0.001），死亡风险高68%（未调整的HR = 1.68，95%CI：1.27 - 2.23）。多因素Cox回归证实AFP阳性是一个独立的预后因素（调整后的HR = 1.8，95%CI：1.03 - 3.14，=0.04），同时还有T4期、N3期和远处转移。与单独的TNM分期相比，整合AFP水平和TNM分期的预后列线图在1年、3年和5年生存率方面具有更高的预测准确性（AUC：0.80 - 0.84）（单独TNM分期的AUC：0.70 - 0.74）。校准和决策曲线分析进一步验证了该模型的临床实用性，支持其在风险分层和治疗规划中的作用。 结论：AFP是胃癌中一个重要的独立预后因素，将其纳入多变量模型可提高生存预测能力。本研究开发的预后列线图为临床医生提供了一个预测患者预后和指导治疗决策的有价值工具。需要进一步的验证和前瞻性研究来确认该模型的临床适用性。
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