Alpha-Fetoprotein is a significant prognostic factor for gastric cancer: Results from a propensity score matching analysis after curative resection

Publication date: Available online 3 May 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Daniel Reim, Yun-Suk Choi, Hong Man Yoon, Boram Park, Bang Wool Eom, Myeong-Cherl Kook, Keun Won Ryu, Il Ju Choi, Jungnam Joo, Young-Woo Kim
BackgroundPrognosis of alpha-fetopotein positive gastric cancer (AFPP-GC) remains elusive so far due to disparities in cohort size and baseline characteristics in previous studies. A propensity score matching (PSM) analysis as well as multivariable model was performed for unbiased evaluation of the outcome in AFPGC.MethodsAmong 3,034 gastric cancer patients who underwent curative gastric cancer surgery (R0, M0) at the National Cancer Center, Korea between 2002 to 2007, we identified 97 patients being positive for AFP either by elevation of serum-AFP levels >10μg/L or by immunohistochemical staining. Due to marked disparities in baseline characteristics and cohort size, propensity-score-matching was performed which matched 87 AFPP-GC patients to the same number of AFP-negative gastric cancer (AFPN-GC) patients. Baseline characteristics were compared using χ2-test. Survival curves were compared using the Kaplan-Meier-method and multivariable regression analysis was performed to evaluate the effect of AFP-positivity while adjusting the effects of confounding variables.ResultsAFPP-GC and AFPN-GC patients revealed marked disparities in patient cohorts. After PSM, groups were balanced for age, sex, tumor size, BMI, tumor location, grade of differentiation, presence of lymphatic vessel infiltration (LVI), Lauren histologic type and stage distribution. In multivariable regression analysis of the PSM-groups, only AFP-positivity and pathologic stage were predictive for overall survival (HR 2.98, CI95% {1.7-5.1}, p<0.0001). Five-year-survival rates were significantly worse for AFPP-GC patients (57.9% vs. 76.1%, p=0.014). Recurrence was significantly more frequent in AFPP-GC patients (p=0.003).ConclusionAFP can be considered as an independent negative predictor of overall and recurrence-free survival in patients with gastric cancer.



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