JOCS

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

EndNote Style
Index
Original Article
Association of serum alpha-fetoprotein (AFP) with indirect prognosis in gastric cancer
Aims: Alpha-fetoprotein (AFP) is a glycoprotein secreted from the yolk sac and hepatocytes during fetal life. Elevated levels in adults are considered markers for yolk sac tumors, hepatocellular carcinoma and gastric cancer. There is still no consensus on the definition of AFP-secreting gastric cancers, but AFP-secreting gastric cancers have been reported to have a worse prognosis. In this study, AFP levels in gastric cancers with high AFP were compared with pathology results and evaluated in terms of indirect prognosis.
Methods: Patients with gastric cancer operated in the General Surgery Clinic of Ankara Bilkent City Hospital between 2019 and 2023 were retrospectively screened. Among the screened patients, those whose information could not be reached and those with incomplete information were excluded and 126 patients were included in the study. Serum AFP levels of these patients were compared with pathology results, stages and tumor sizes.
Results: The mean age of the patients in our study was 66±11 years, 42 (33.6%) were female and 84 (66.7%) were male. Of the 126 patients analyzed in the study, 107 (84.9%) were AFP-negative and 19 (15.1%) were AFP-positive. There was no significant difference in AFP levels between all patients in terms of liver metastasis, peritoneal metastasis, disease stage, perineural invasion and tumor location. However, serum AFP levels were significantly higher in patients with lymphovascular invasion and lung metastases (p=0.042; p=0.024). In the analysis for serum AFP level in the presence of lymphovascular invasion, ROC value was 2.35 ng/ml, sensitivity 58.2%, specificity 55.9%, area under the curve (AUC) 0.618, 95% confidence interval (95% CI) 0.512-0.723 and p=0.028.
Conclusion: Lymphovascular invasion is a poor prognostic factor in gastric cancer. In this study, a significant correlation was found between serum AFP value and lymphovascular invasion. In gastric cancers without AFP secretion, a serum AFP value above 2.35 ng/ml may be indirectly associated with poor prognosis because it predicts lymphovascular invasion.


1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality worldwide for 36cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-263. doi:10.3322/caac.21834
2. Lu M, Yang Z, Feng Q, et al. The characteristics and prognostic value ofsignet ring cell histology in gastric cancer: a retrospective cohort studyof 2199 consecutive patients. Medicine (Baltimore). 2016;95(27):e4052.doi:10.1097/MD.0000000000004052
3. Zhao L, Yang C, Lin Y, Wang S, Ye Y, Shen Z. Research progress andprospects of AFP-positive gastric cancer. Foregut Surg. 2022;2(1):29-38.
4. Abdelwahab H, Tageldin O, Hasak S, Lee H. AFP-producing gastriccarcinoma. Hum Pathol. 2022;28:300640.
5. Hirajima S, Komatsu S, Ichikawa D, et al. Liver metastasis is the onlyindependent prognostic factor in AFP-producing gastric cancer. WorldJ Gastroenterol. 2013;19(36):6055.
6. Xu X, Wang Q, Cao H, et al. Prognostic value of serum alpha-fetoprotein levels in patients with gastric cancer: a meta-analysis. J IntMed Res. 2020;48(3):0300060519899780.
7. Fujikawa H, Koumori K, Watanabe H, et al. The clinical significanceof lymphovascular invasion in gastric cancer. In Vivo. 2020;34(3):1533-1539. doi:10.21873/invivo.11942
8. Lu J, Dai Y, Xie J-W, et al. Combination of lymphovascular invasionand the AJCC TNM staging system improves prediction of prognosisin N0 stage gastric cancer: results from a high-volume institution. BMCCancer. 2019;19:1-9.
9. Mei D, Zhao B, Zhang J, et al. Impact of lymphovascular invasion onsurvival outcome in patients with gastric cancer: a retrospective cohortstudy. Am J Clin Pathol. 2020;153(6):833-841.
10. Kunisaki C, Makino H, Kimura J, et al. Impact of lymphovascularinvasion in patients with stage I gastric cancer. Surgery. 2010;147(2):204-211.
11. Zhang CD, Ning FL, Zeng XT, Dai DQ. Lymphovascular invasion as apredictor for lymph node metastasis and a prognostic factor in gastriccancer patients under 70 years of age: a retrospective analysis. Int J Surg.2018;53:214-220.
12. Choi S, Song JH, Lee S, et al. Lymphovascular invasion: traditional butvital and sensible prognostic factor in early gastric cancer. Ann SurgOncol. 2021;28(13):8928-8935.
13. Japanese Gastric Cancer Association. Japanese Gastric CancerTreatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26(1):1-25. doi:10.1007/s10120-022-01331-8
14. Liu D, Li B, Yan B, et al. The clinicopathological features and prognosisof serum AFP positive gastric cancer: a report of 16 cases. Int J Clin ExpPathol. 2020;13(9):2439.
15. Chun H, Kwon SJ. Clinicopathological characteristics of alpha-fetoprotein-producing gastric cancer. J Gastric Cancer. 2011;11(1):23.
16. Lin H, Hsieh Y, Fang W, Huang K, Li A. Clinical manifestations inpatients with alpha-fetoprotein-producing gastric cancer. Curr Oncol.2014;21(3):394-399.
17. Wang YK, Shen L, Jiao X, Zhang XT. Predictive and prognostic valueof serum AFP level and its dynamic changes in advanced gastric cancerpatients with elevated serum AFP. World J Gastroenterol. 2018;24(2):266.
Volume 2, Issue 3, 2024
Page : 45-48
_Footer