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

Background: Elevated serum alpha-fetoprotein (AFP) levels in adults are considered abnormal. This parameteris used mostly in the diagnosis and follow-up of hepatocellular carcinomas and yolk sac tumors. Among the otherrare tumors accompanied with elevated serum AFP levels, gastric cancer is the most common. In this study, weevaluated the follow-up and comparison of the treatment and marker response of patients with metastatic gastriccancer who had elevated serum AFP levels. Materials and
Methods: We performed a retrospective study, includingall consecutive patients with advanced gastric cancer, who received systemic chemotherapy with elevated AFPlevel.
Results: Seventeen metastatic gastric cancer patients with elevated AFP levels at the time of diagnosis wereevaluated. Fourteen (82.4%) were males and three (17.6%) were females. The primary tumor localization wasthe gastric body in 8 (76.4%), cardia in 7 (41.2%), and antrum in 2 (11.8%). Hepatic metastasis was observed in13 (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 responsewas 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: Followupof AFP levels in metastatic gastric cancer patients with elevated AFP levels may allow prediction of earlytreatment response and could be more useful than the CEA marker for follow-up in response evaluation.