Patient selection: gastric carcinoma producing AFP (serum AFP elevated, tumor positive on immunostaining for AFP)
Independent factors affecting prognosis:
(1) surgical curability
(2) tumor stage
|
Parameter
|
Finding
|
Points
|
|
surgical curability
|
achieved (completely resected)
|
0
|
|
|
failed (not completely resected)
|
1
|
|
tumor stage
|
Stage I or II
|
0
|
|
|
Stage III or IV
|
1
|
Features of Stage III and IV tumors (AJCC TNM):
(1) any T4 (direct extension into an adjacent organ)
(2) T3 (penetration of the serosal surface) with N1 to N3
(3) T2 with N2 or N3
(4) T1 with N3
(5) any M1
number of poor prognostic factors =
= (points for surgical curability) + (points for tumor stage)
Interpretation:
• minimum number of poor prognostic factors: 0
• maximum number of poor prognostic factors: 2
|
Number of Poor Prognostic Factors
|
Prognosis
|
|
0
|
good
|
|
1
|
guarded
|
|
2
|
poor
|
Other factors associated with survival (not independent):
(1) serum AFP level (measure of tumor burden)
(2) diameter of the tumor in cm (measure of tumor burden
(3) serosal invasion (included in stage)
(4) lymph node metastases (included in stage)
(5) liver metastases (included in stage)
If the serum AFP is elevated at diagnosis, then:
(1) complete resection is associated with drop in serum levels to normal
(2) incomplete resection or recurrence is associated with an incomplete drop, continued elevated serum levels, or an initial drop followed by an increase
