title: Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer.
abstract: BACKGROUND
  Patients with alpha-fetoprotein (afp)-producing gastric cancer have a high incidence of liver metastasis and poor prognosis. There is some controversy about clinical manifestations in these patients.
  
  
  METHODS
  Our study enrolled patients who, before surgery, had gastric cancer with serum afp exceeding 20 ng/mL [afp>20 (n = 58)] and with serum afp 20 ng/mL or less [afp≤20 (n = 1236)]. Clinical manifestations were compared between the groups.
  
  
  RESULTS
  Early gastric cancer was more frequent (30.1% vs. 4%) and advanced gastric cancer was less frequent (69.9% vs. 96%) in the afp≤20 group than the afp>20 group (p < 0.001). Liver and lymph node metastasis occurred less frequently in the afp≤20 group (4.4% vs. 27.6%, p < 0.001, and 60.7% vs. 91.4%, p < 0.001, respectively). The 1-, 3-, 5-, and 10-year survival rates of afp≤20 patients were 75.2%, 53.4%, 45.8%, and 34.6% respectively. The 1-, 3-, 5-, and 10-year survival rates of patients with afp greater than 20 ng/mL, but 300 ng/mL or less, were 46.7%, 28.9%, 17.8%, and 13.3% respectively. The 1-, 3-, and 5-year survival rates of patients with serum afp greater than 300 ng/mL were 15.4%, 7.7%, and 0% respectively. The independent predictors for survival time were afp concentration, age, peritoneal seeding, liver metastasis, lymph node metastasis, vascular invasion, TNM stage, curative surgery, serosal invasion, and Lauren classification.
  
  
  CONCLUSIONS
  Patients with high serum afp had a high frequency of liver and lymph node metastasis and very poor prognosis. More aggressive management with multimodal therapy (for example, chemotherapy, radiotherapy) might be needed when treating such patients.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei City, Taiwan. ; School of Medicine, Taipei Medical University, Taipei City, Taiwan.
authors.forename: H J
authors.initials: HJ
authors.lastname: Lin
authors.affiliation: Division of Gastroenterology, Department of Medicine, Buddhist Dalin Tzu Chi General Hospital, Chia-Yi, Taiwan. ; Buddhist Tzu Chi University, School of Medicine, Hualien City, Taiwan.
authors.forename: Y H
authors.initials: YH
authors.lastname: Hsieh
authors.affiliation: Division of General Surgery, Veterans General Hospital-Taipei, Taipei City, Taiwan. ; School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: W L
authors.initials: WL
authors.lastname: Fang
authors.affiliation: Division of General Surgery, Veterans General Hospital-Taipei, Taipei City, Taiwan. ; School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
authors.forename: K H
authors.initials: KH
authors.lastname: Huang
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei City, Taiwan. ; Department of Pathology, Veterans General Hospital-Taipei, Taipei City, Taiwan.
authors.forename: A F Y
authors.initials: AF
authors.lastname: Li
keywords: Gastric cancer; alpha-fetoprotein; early gastric cancer; metastasis