title: Long-term results of gastrectomy for alpha-fetoprotein-producing gastric cancer.
abstract: BACKGROUND
  alpha-Fetoprotein (AFP)-producing gastric cancer is a rare tumour. It is said to have a high incidence of liver metastasis and poor prognosis. This study sought to evaluate long-term outcomes in such patients.
  
  
  METHODS
  Records of consecutive patients with gastric carcinoma who underwent preoperative measurement of serum AFP levels and gastrectomy were reviewed to identify those who satisfied the following criteria: preoperative AFP level exceeding 40 ng/ml with a decrease after gastrectomy, or raised preoperative AFP level (10-39 ng/ml) and resected tumour showing histologically characteristic features or immunohistochemically positive AFP production.
  
  
  RESULTS
  Of 3374 patients with gastric cancer, 53 (1.6 per cent) met the selection criteria. Tumours were characterized by a high incidence of nodal (79 per cent) or liver (53 per cent) metastasis. Preoperative serum AFP levels showed no correlation with tumour size, depth of invasion, disease stage or survival. The 5-year survival rate was 34 per cent. Five patients survived after recurrence following multimodal treatment. A rising AFP level during follow-up always led to tumour recurrence, but the level remained normal in 11 of 31 patients with recurrence.
  
  
  CONCLUSIONS
  AFP-producing tumours represent a small subgroup of gastric cancer with high metastatic potential. Postoperative serum AFP level can help predict recurrence but a normal level does not mean absence of recurrence. Prognosis is not as poor as previously thought, and multimodal treatment may be worthwhile even in patients with recurrent tumour.
authors.affiliation: Gastric Surgery Division, National Cancer Centre Hospital, Tokyo, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Inoue
authors.forename: T
authors.initials: T
authors.lastname: Sano
authors.forename: A
authors.initials: A
authors.lastname: Kuchiba
authors.forename: H
authors.initials: H
authors.lastname: Taniguchi
authors.forename: T
authors.initials: T
authors.lastname: Fukagawa
authors.forename: H
authors.initials: H
authors.lastname: Katai
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D013274:Stomach Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
chemical_list: D000509:alpha-Fetoproteins