Clinicopathologic and Immunohistochemical Study on α-fetoprotein Producing Early Gastric Cancer with Liver Metastasis

Shou Ishihara, Akio Yanagisawa and Takashi Takahashi

Department of Surgery, Department of Pathology, Cancer Institute Hospital

The reccurrence of early gastric cancer is rare, with liver metastasis showing the highest incidence of reccurrence. The relationship between liver metastasis and α-fetoprotein producing early gastric cancer has often been reported, however what this relationship actually implies is not clear due to the small number of patients. We studied 14 early gastric cancer patients with liver metastasis (0.8%) among a series of 1,744 early gastric cancer patients who underwent surgery in our department between 1980 and 1995 to evaluate this relationship using clinicopathologic, findings serum AFP, and immunohistochemical (AFP) procedures. Clinicopathologic features were as follows: (1) submucosal carcinoma: 14/14, (2) differentiated adenocarcinoma:13/14 (so-called hepatoid adenocarcinoma: 6/14), and (3) a high incidence of lymph node involvement: 10/14. We selected patients having these features who had lived over 5 years without liver metastasis, and compared them. Hepatoid carcinoma was not found in controls (p=0.0004). Abnormal serum AFP in patients with liver metastasis was seen in 9/14 (64%). No controls had abnormal serum AFP (p<0.0001). Five patients with liver metastasis were positive for immunostaining (AFP) for tumors, compared to only one among the controls (p=0.0089), indicating that differentiation to AFP producing tumors would begin at the stage of submucosal cancer. Of these patients, 9 (64%) were considered to have AFP producing early gastric cancer, so the 64% relationship between liver metastasis and AFP producing tumors in early gastric cancer patients with liver metastasis appears meaningful. It is important to detect patients with early gastric cancer who will develop liver metastasis as indicated by AFP producing tumors.

Key words
early gastric cancer, liver metastasis, AFP

Reprint requests
Shou Ishihara Department of Surgery, Cancer Institute Hospital 1-37-1 Kamiikebukuro, Toshima-ku, Tokyo, 170-8455 JAPAN

Accepted
May 25, 1999

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