ROLES OF HISTOLOGICAL-FINDINGS AND SERUM AFP LEVELS IN THE PROGNOSIS OF AFP-PRODUCING GASTRIC CANCERS

We investigated the roles of histological findings and serum AFP level s in the prognosis of gastric cancers which produce AFP. We considered the typical features of such gastric cancers to be the medullary grow th of undifferentiated cancer cells with clear, or slightly eosinophil ic, abundant cytoplasm and pleomorphic large round nuclei, forming eit her papillary clear carcinomas or hepatoid carcinomas. Seventeen patie nts with AFP-producing gastric cancers were observed in the period, 19 79-1991. They were divided into two groups: those with (n 5) and those without (n 12) the typical histological features mentioned above. The ir clinicopathological findings and prognoses were compared. Both grou ps showed a male dominance, gross Borrmann's type 2 or 3 appearances, diagnoses made at an advanced stage and metastatic involvements of the liver. The patients with the typical histological features showed a s ignificantly higher AFP serum level and a significantly shorter surviv al. The patients who lacked the typical findings, and with serum AFP l evels greater-than-or-equal-to 100 ng/ml, had poorer prognoses, while those lacking the typical histological features, and serum AFP levels < 100 ng/ml had better prognoses. The combination of histological find ings and serum AFP level appeared to be useful in predicting the progn osis of AFP-producing gastric cancers. Intensive adjuvant therapy, e.g ., chemotherapy administered via hepatic arterial infusion, may be ind icated for patients at a high risk of recurrence following curative su rgery.