title: Salvage surgery after chemotherapy with S-1 plus cisplatin for α-fetoprotein-producing gastric cancer with a portal vein tumor thrombus: a case report.
abstract: BACKGROUND
  Patient with α-Fetoprotein (AFP)-producing gastric cancer usually has a short survival time due to frequent hepatic and lymph node metastases. Gastric cancer with portal vein tumor thrombus (PVTT) is rare and has an extremely poor prognosis.
  
  
  METHODS
  A 63-year-old man was found to have a huge Type 3 gastric cancer with a PVTT and a highly elevated serum AFP level. Chemotherapy with S-1 plus cisplatin was given to this patient with unresectable gastric cancer for 4 months. The serum AFP level decreased from 6,160 ng/mL to 60.7 ng/mL with chemotherapy. Since the PVTT disappeared after the chemotherapy, the patient underwent total gastrectomy. Histological findings of the primary tumor after chemotherapy showed poorly differentiated adenocarcinoma without hepatoid cells and viable tumor cells remaining in less than 1/3 of the neoplastic area of mucosa and one lymph node. The cancerous cells were immunohistochemically stained by anti-AFP antibody. The patient has survived for 48 month without recurrence.
  
  
  CONCLUSIONS
  AFP-producing gastric cancer with a PVTT has an extremely poor prognosis, but long-term survival was achieved for this dismal condition by salvage surgery after chemotherapy.
authors.forename: Shigetomi
authors.initials: S
authors.lastname: Nakao
authors.affiliation: Department of Surgery, Kashiwara Municipal Hospital, 1-7-9 Hozenji, Kashiwara City, Osaka 582-0005, Japan. bunzo@med.osaka-cu.ac.jp.
authors.forename: Bunzo
authors.initials: B
authors.lastname: Nakata
authors.forename: Masashige
authors.initials: M
authors.lastname: Tendo
authors.forename: Kenji
authors.initials: K
authors.lastname: Kuroda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hori
authors.forename: Mayumi
authors.initials: M
authors.lastname: Inaba
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ishikawa
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood*; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage; D004338:Drug Combinations; D005743:Gastrectomy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010094:Oxonic Acid / Q000008:administration & dosage; D011169:Portal Vein; D016879:Salvage Therapy; D013274:Stomach Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D005641:Tegafur / Q000008:administration & dosage; D013927:Thrombosis / Q000188:drug therapy / Q000209:etiology*; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D004338:Drug Combinations; D000509:alpha-Fetoproteins; C079198:S 1 (combination); D005641:Tegafur; D010094:Oxonic Acid; D002945:Cisplatin