Prognostic value of serum alpha-fetoprotein levels in patients with gastric cancer: a meta-analysis

BACKGROUND: To investigate the prognostic value of pre-treatment serum alpha-fetoprotein (AFP) levels in patients with gastric cancer (GC). METHODS: PubMed, EMBASE, Medline and Web of Science databases were systematically searched for studies published between January 01, 1998 and December 31, 2018 that investigated the relationship between pre-treatment serum AFP levels and prognosis of patients with GC. Hazard ratios (HR) for overall survival (OS), disease-free survival (DFS), and their corresponding 95% confidence intervals (CIs) were evaluated. RESULTS: 13 studies involving 9099 patients with GC were included in the meta-analysis. High pre-treatment serum AFP levels were significantly associated with poor outcome in patients with GC. Although there was significant heterogeneity between studies, sub-group analyses found that studies of ‘non-China’ countries, sample size <500, mixed treatment, or AFP cut-off value ≥20 ng/ml, had low heterogeneity. CONCLUSIONS: The pooled analysis suggests that pre-treatment serum AFP levels can be used as a prognostic indicator in patients with GC. Further research is required to confirm these results.