Serum �±-fetoprotein- (AFP-) elevated gastric cancer is a rare tumor that has a poor prognosis due to high incidence of liver\nmetastasis. This study sought to investigate the optimal treatment modality. A total of 319 gastric cancer patients with liver\nmetastasis (GCLM) whose serum AFP levels were tested before treatment were enrolled in this study. They were classified as the\nserum AFP â�¥ 20 ng/ml group (n = 74) and the AFP < 20 ng/ml group (n = 245). Median OS of the AFP < 20 ng/ml group was\nsignificantly longer than that of the AFP â�¥ 20 ng/ml group (15.7m versus 10.9 m, P = 0 004). ORR of first-line chemotherapy\nwas 43.3% and 56.1% of the two groups, respectively (P = 0 024). Of patients who received doublet regimen, ORR of the\nAFP â�¥ 20 ng/ml group was significantly lower (38.2 versus 56.9%, P = 0 013), while in those received triplet regimens, ORR\nbetween two groups was similar (66.7% versus 66.7%, P = 0 676). Moreover, for patients of the AFP â�¥ 20 ng/ml group, those who\nreached PR had a longer survival period (15.4m versus 9.4 m, P = 0 017), and combined with local treatment for liver metastasis\nalso seemed to improve prognosis (19.2m versus 8.4 m, P = 0 003). In conclusion, serum AFP-elevated GCLM had a poorer\nprognosis. Multimodality treatment including aggressive first-line chemotherapy with triplet regimen may be needed when\ntreating them.
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