Brief Article
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World J Gastroenterol. Sep 28, 2013; 19(36): 6055-6061
Published online Sep 28, 2013. doi: 10.3748/wjg.v19.i36.6055
Liver metastasis is the only independent prognostic factor in AFP-producing gastric cancer
Shoji Hirajima, Shuhei Komatsu, Daisuke Ichikawa, Takeshi Kubota, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Hisashi Ikoma, Eigo Otsuji
Shoji Hirajima, Shuhei Komatsu, Daisuke Ichikawa, Takeshi Kubota, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Hirotaka Konishi, Hisashi Ikoma, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
Author contributions: Hirajima S and Komatsu S contributed equally to this work; Hirajima S, Komatsu S and Ichikawa D designed the research; Hirajima S, Komatsu S, Ichikawa D, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Konishi H, Ikoma H and Otsuji E performed the research; Hirajima S and Komatsu S analyzed the data and wrote the manuscript.
Correspondence to: Shuhei Komatsu, MD, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachihirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. skomatsu@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: May 7, 2013
Revised: July 20, 2013
Accepted: August 8, 2013
Published online: September 28, 2013
Abstract

AIM: To investigate differences between common gastric cancer and α-fetoprotein (AFP)-producing gastric cancer according to the presence or absence of liver metastasis.

METHODS: Between 1997 and 2011, 1299 patients underwent gastrectomy for gastric cancer (GC) at our institute and their hospital records were reviewed retrospectively. Patients were immunohistochemically divided into two groups: 23 patients (1.8%) with AFP-producing GC and 1276 patients (98.2%) without it.

RESULTS: AFP-producing GC patients had a significantly higher incidence of deeper tumors, venous invasion, lymphatic invasion, lymph node metastasis, and liver metastasis and a poorer prognosis (P < 0.005) than those without AFP-producing GC. However, multivariate analysis revealed that AFP-positivity was not an independent prognostic factor. The prognosis of AFP-producing GC was similar to that of AFP-non producing GC according to the presence or absence of liver metastasis. Concerning recurrence, 47.8% of patients (11/23) with AFP-producing GC and 20.0% of patients (256/1276) without AFP-producing GC exhibited recurrence. Liver metastasis [90.9% (10/11)] was the most prevalent in AFP-producing GC patients. Multivariate analysis revealed that liver metastasis was the only independent prognostic factor in AFP-producing GC (HR = 17.6, 95%CI: 2.1-147.1; P = 0.0081).

CONCLUSION: AFP-producing GC is similar to common GC without liver metastasis, which should be specifically targeted in an effort to improve the prognosis of AFP-producing GC patients.

Keywords: α-fetoprotein, Gastric cancer, Liver metastasis, Poor prognosis, Immunostaining

Core tip: In the present study, we re-evaluated the clinicopathological characteristics and clinical outcomes of consecutive patients with α-fetoprotein (AFP)-producing gastric cancer (GC). The results obtained clearly demonstrated that clinical behaviors were different between patients with and without AFP-producing GC. However, the prognosis according to the presence or absence of liver metastasis was similar between patients with and without AFP-producing GC. Our results show that liver metastasis should be specifically targeted in an effort to improve the prognosis of AFP-producing GC.