Roles of histological findings and serum AFP levels in the prognosis of AFP-producing gastric cancers.

We investigated the roles of histological findings and serum AFP levels in the prognosis of gastric cancers which produce AFP. We considered the typical features of such gastric cancers to be the medullary growth of undifferentiated cancer cells with clear, or slightly eosinophilic, abundant cytoplasm and pleomorphic large round nuclei, forming either papillary clear carcinomas or hepatoid carcinomas. Seventeen patients with AFP-producing gastric cancers were observed in the period, 1979-1991. They were divided into two groups: those with (n 5) and those without (n 12) the typical histological features mentioned above. Their clinicopathological findings and prognoses were compared. Both groups showed a male dominance, gross Borrmann's type 2 or 3 appearances, diagnoses made at an advanced stage and metastatic involvements of the liver. The patients with the typical histological features showed a significantly higher AFP serum level and a significantly shorter survival. The patients who lacked the typical findings, and with serum AFP levels > or = 100 ng/ml, had poorer prognoses, while those lacking the typical histological features, and serum AFP levels < 100 ng/ml had better prognoses. The combination of histological findings and serum AFP level appeared to be useful in predicting the prognosis of AFP-producing gastric cancers. Intensive adjuvant therapy, e.g., chemotherapy administered via hepatic arterial infusion, may be indicated for patients at a high risk of recurrence following curative surgery.