DOI QR코드

DOI QR Code

Alpha-fetoprotein (AFP) Elevation Gastric Adenocarcinoma and Importance of AFP Change in Tumor Response Evaluation

  • Tatli, Ali Murat (Department Oncology Medical, Van Training and Research Hospital) ;
  • Urakci, Zuhat (Department Oncology Medical, Dicle University, Medical Faculty) ;
  • Kalender, Mehmet Emin (Department Oncology Medical, Gaziantep University, Medical Faculty) ;
  • Arslan, Harun (Department Radiology, Van Training and Research Hospital) ;
  • Tastekin, Didem (Department Oncology Medical, IstanbulUniversity, Medical Faculty) ;
  • Kaplan, Mehmet Ali (Department Oncology Medical, Dicle University, Medical Faculty)
  • Published : 2015.03.18

Abstract

Background: Elevated serum alpha-fetoprotein (AFP) levels in adults are considered abnormal. This parameter is used mostly in the diagnosis and follow-up of hepatocellular carcinomas and yolk sac tumors. Among the other rare tumors accompanied with elevated serum AFP levels, gastric cancer is the most common. In this study, we evaluated the follow-up and comparison of the treatment and marker response of patients with metastatic gastric cancer who had elevated serum AFP levels. Materials and Methods: We performed a retrospective study, including all consecutive patients with advanced gastric cancer, who received systemic chemotherapy with elevated AFP level. Results: Seventeen metastatic gastric cancer patients with elevated AFP levels at the time of diagnosis were evaluated. Fourteen (82.4%) were males and three (17.6%) were females. The primary tumor localization was the gastric body in 8 (76.4%), cardia in 7 (41.2%), and antrum in 2 (11.8%). Hepatic metastasis was observed in 13 (76.4%) at the time of diagnosis. When the relationship of AFP levels and carcinoembryonic antigen (CEA) response of the patients with their radiologic responses was evaluated, it was found that the radiologic response was compatible with AFP response in 16 (94.1%) patients and with CEA response in 12 (70.6%); however, in 5 (29.4%) patients no accordance was observed between radiological and CEA responses. Conclusions: Follow-up of AFP levels in metastatic gastric cancer patients with elevated AFP levels may allow prediction of early treatment response and could be more useful than the CEA marker for follow-up in response evaluation.

Keywords

Alpha-fetoprotein;chemotherapy;gastric cancer;CEA

References

  1. Akai S, Kato K (1973). Serum ${\alpha}$-fetoprotein-positive stomach cancer. Gann Monogr, 14, 149-54.
  2. Baek SK, Han SW, Oh DY, et al (2011). Clinic pathologic characteristics and treatment outcomes of hepatoid adenocarcinoma of the stomach, a rare but unique subtype of gastric cancer. BMC Gastroenterol, 11, 1-7. https://doi.org/10.1186/1471-230X-11-1
  3. Bourreille J, Metayer P, Sauger F, et al (1970). Existence of alpha feto protein during gastric-origin secondary cancer of the liver. Presse Med, 78, 1277-8.
  4. Chang YC, Nagasue N, Abe S, et al (1990). The characteristics of AFP-producing early gastric cancer. J Jpn Surg Soc, 91, 1574-80.
  5. Chang YC, Nagasue N, Abe S, et al (1992). Comparison between the clinicopathologic features of AFP-positive and AFPnegative gastric cancers. Am J Gastroenterol, 87, 321-5.
  6. Chun H, Kwon SJ (2011). Clinic pathological characteristics of alpha-fetoprotein-producing gastric cancer. J Gastric Cancer, 11, 23-30. https://doi.org/10.5230/jgc.2011.11.1.23
  7. Gitlin D, Pericelli A, Gitlin GM (1972). Synthesis of-fetoprotein by liver, yolk sac, and gastrointestinal tract of the human conceptus. Cancer Res, 32, 979-82.
  8. Hamanaka W, Yoneda S, Shirakusa T, et al (2008). Alphafetoprotein (AFP)-producing adrenocortical carcinoma-long survival with various therapeutic strategies including a lung resection: Report of a case. Surg Today, 38, 275-8. https://doi.org/10.1007/s00595-007-3610-9
  9. Hocking GR, Shembrey M, Hay D, et al (1995). Alphafetoprotein- producing adenocarcinoma of the sigmoid colon with possible hepatoid differentiation. Pathology, 27, 277-9. https://doi.org/10.1080/00313029500169113
  10. Inoue M, Sano T, Kuchiba A, et al (2008). Long-term results of gastrectomy for $\alpha$-fetoprotein-producing gastric cancer. Br J Surg, 97, 1056-61.
  11. Isonishi S, Ogura A, Kiyokawa T, et al (2009). Alpha-fetoprotein (AFP)- producing ovarian tumor in an elderly woman. Int J Clin Oncol, 14, 70-3. https://doi.org/10.1007/s10147-008-0800-4
  12. Lin HJ, Hsieh Y.H, Fang WL, et al (2014). Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer. Curr Oncol, 21, 394-9. https://doi.org/10.3747/co.21.1768
  13. Liu X, Cheng Y, Sheng W, et al (2010). Analysis of clinicopathologic features and prognostic factors in hepatoid adenocarcinoma of the stomach. Am J SurgPathol, 34, 1465-71.
  14. Liu X, Cheng Y, Sheng W, et al (2010). Clinicopathologic features and prognostic factors in alpha-fetoproteinproducing gastric cancers: analysis of 104 cases. J Surg Oncol, 102, 249-55. https://doi.org/10.1002/jso.21624
  15. Maruyama K, Kaminishi M, Hayashi K, et al (2006). Gastric cancer treated in 1991 in Japan: data analysis of nationwide registry. Gastric Cancer, 9, 51-66. https://doi.org/10.1007/s10120-006-0370-y
  16. Marx GM, Boyce A, Goldstein D (2002). Elevated $\alpha$-fetoprotein and hepatic metastases-it's not always what it seems! Ann Oncol, 13, 167-9.
  17. McIntire KR, Waldmann TA, Moertel CG, et al (1971). Serum alpha-fetoprotein in patients with neoplastic carcinomas. N Engl J Med, 285, 1060-1. https://doi.org/10.1056/NEJM197111042851907
  18. Mittal A, Gupta SP, Jha DK, et al (2013). Impact of various tumor markers in prognosis of gastric cancer. a hospital based study from tertiary care hospital of Kathmandu valley. Asian Pac J Cancer Prev, 14, 1965-7. https://doi.org/10.7314/APJCP.2013.14.3.1965
  19. Motoyama T, Aizawa K, Watanabe H, et al (1993). Alphafetoprotein- producing gastric carcinomas: A comparative study of three different subtypes. Acta Pathol Jpn, 43, 654-61.
  20. Nagai E, Ueyama T, Yao T, et al (1993). Hepatoid adenocarcinoma of the stomach. Cancer, 72, 1827-35. https://doi.org/10.1002/1097-0142(19930915)72:6<1827::AID-CNCR2820720606>3.0.CO;2-8
  21. Riaz A, Ryu RK, Kulik LM, et al (2009). Alpha-fetoprotein response after locoregional therapy for hepatocellular carcinoma: oncologic marker of radiologic response, progression, and survival. J Clin Oncol, 27, 5734-42. https://doi.org/10.1200/JCO.2009.23.1282
  22. Saito S, Hatano T, Hayakawa M, et al (1989). Studies on alphafetoprotein produced by renal cell carcinoma. Cancer, 63, 544-9. https://doi.org/10.1002/1097-0142(19890201)63:3<544::AID-CNCR2820630324>3.0.CO;2-2
  23. Shibata Y, Sato K, Kodama M, et al (2007). Alpha-fetoproteinproducing early gastric cancer of the remnant stomach: Report of a case. Surg Today, 37, 995-9. https://doi.org/10.1007/s00595-007-3501-0
  24. Shu J, Li CG, Liu YC, et al (2012). Comparison of serum tumor associated material (TAM) with conventional biomarkers in cancer patients. Asian Pac J Cancer Prev, 13, 2399-403. https://doi.org/10.7314/APJCP.2012.13.5.2399
  25. Takahashi Y, Mai O, Ogino T, et al (1987). Clinicopathological study of AFP-producing gastric cancer. Significance of AFP in gastric cancer. J Jpn Surg Soc, 88, 696-700.
  26. Trompetas V, Varsamidakis N, Frangia K, et al (2003). Gastric hepatoid adenocarcinoma and familial investigation: does it always produce alpha-fetoprotein? Eur J Gastroenterol Hepatol, 15, 1241-4. https://doi.org/10.1097/00042737-200311000-00015
  27. Turkdogan MK, Akman N, Tuncer I, et al (1998). The high prevalence of esophageal and gastric cancers in Eastern Turkey. Med Biol Environ, 26, 79-84.
  28. Turkdogan MK, Testereci H, Akman N, et al (2003). Dietary nitrate and nitrite levels in an endemic upper gastrointestinal (esophageal and gastric) cancer region of Turkey. Turk J Gastroenterol, 14, 50-3.
  29. Ueno M, Nakashima J, Ohigashi T, et al (2001). Establishment of a testicular carcinoma cell line producing alpha-fetoprotein. BJU Int, 88, 611-21.
  30. Yamagata T, Yamagata Y, Nakanishi M, et al (2004). A case of primary lung cancer producing alpha-fetoprotein. Can Respir J, 11, 504-6. https://doi.org/10.1155/2004/510350
  31. Yamao T, Kai S, Kazami A, et al (1999). Tumor markers CEA, CA19-9 and CA125in monitoring of response to systemic chemotherapy in patients with advanced gastric cancer. Jpn J Clin Oncol, 29, 550-5. https://doi.org/10.1093/jjco/29.11.550
  32. Zhang JF, Shi SS, Shao YF, et al (2011). Clinic pathological and prognostic features of hepatoid adenocarcinoma of the stomach. Chin Med J, 124, 1470-6.

Cited by

  1. Clinical Application of Serum Tumor Abnormal Protein from Patients with Gastric Cancer vol.16, pp.9, 2015, https://doi.org/10.7314/APJCP.2015.16.9.4041
  2. A case report of targeted therapy with apatinib in a patient with advanced gastric cancer and high serum level of alpha-fetoprotein vol.95, pp.37, 2016, https://doi.org/10.1097/MD.0000000000004610
  3. The AFP tumour marker vol.68, pp.3, 2018, https://doi.org/10.1007/s40664-017-0260-7