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Abstract：
Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare and aggressive subtype of gastric cancer associated with poor prognosis. This study aimed to investigate the recurrent metastatic patterns and prognostic factors in AFPGC patients undergoing radical surgical resection. Data from 241 AFPGC patients diagnosed between January 2017 and January 2020 who underwent surgical resection were analyzed across multiple centers. Recurrence patterns, metastatic sites, and survival outcomes were evaluated. Univariate and multivariate analyses were performed to identify risk factors for recurrent metastasis, overall survival (OS), and disease-free survival (DFS). There is an annual increase in the proportion of AFPGC cases, rising from 3.45% in 2017 to 7.88% in 2023. Higher serum AFP level was associated with increased likelihood of lymph node metastasis (P=0.006), deeper invasion depth (P=0.000) and greater tumor diameter (P=0.036). Independent predictors of recurrent metastasis included T4 infiltration, lymph node metastasis, tumor diameter >5 cm, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP levels. The 5-year OS and DFS rates were 36.5% and 34.2%, respectively, with poorer survival linked to higher preoperative AFP levels and postoperative increasing trend in AFP level. Independent risk factors for poor OS and DFS included T4 infiltration, lymph node metastasis, poorly differentiated-undifferentiated pathology, preoperative AFP>1000 ng/mL, and postoperative increasing trend in AFP. Serum AFP level can serve as a potential predictive and prognostic biomarker. Identifying independent risk factors informs risk stratification and personalized treatment for AFPGC patients.
摘要：
产生甲胎蛋白的胃癌（AFPGC）是一种罕见的侵袭性胃癌亚型，预后不良。本研究旨在探讨接受根治性手术切除的AFPGC患者的复发转移模式和预后因素。在多个中心分析了2017年1月至2020年1月诊断的241例AFPGC患者的数据，这些患者接受了手术切除。递归模式，转移部位，和生存结局进行评估。进行单因素和多因素分析以确定复发转移的危险因素。总生存期（OS），无病生存率（DFS）。AFPGC病例比例逐年上升,从2017年的3.45%上升到2023年的7.88%。较高的血清AFP水平与淋巴结转移的可能性增加相关(P=0.006)。肿瘤浸润深度较深(P=0.000),肿瘤直径较大(P=0.036)。复发转移的独立预测因素包括T4浸润，淋巴结转移,肿瘤直径>5厘米，低分化-未分化病理，术前AFP>1000ng/mL，术后AFP水平有升高趋势。5年OS和DFS率分别为36.5%和34.2%，分别,较低的生存率与较高的术前AFP水平和术后AFP水平的增加趋势有关。OS和DFS差的独立危险因素包括T4浸润，淋巴结转移,低分化-未分化病理，术前AFP>1000ng/mL，术后AFP呈升高趋势。血清AFP水平可以作为潜在的预测和预后生物标志物。识别独立的危险因素可告知AFPGC患者的风险分层和个性化治疗。
