Wang B, Xie Y, Zheng L, et al. - Serum alpha-fetoprotein (AFP) level as well as immunohistochemical expression of AFP/glypican-3 (GPC3)/spalt-like transcription factor 4 (SALL4) were revealed as valuable indicators of a poor prognosis for gastric adenocarcinoma.

• This study involved 421 non-neoadjuvant surgically or endoscopically resected gastric adenocarcinoma patients with serum AFP results before surgery (group A), and 12 non-resected gastric adenocarcinoma patients with serum AFP ≥ 7 ng/mL prior to treatment (group B).

• In group A, patients with high serum AFP mainly had tubular adenocarcinoma with later pT and pN categories and more lymphovascular invasion, perineural spread, and metastases or recurrence.

• For immunohistochemistry, 34 (8.08%) cases were gastric adenocarcinoma with primitive enterocyte phenotype (GAPEP), and these cases exhibited later pT categories vs non-GAPEP cases.

• Usefulness of both the serological and immunohistochemical methods for predicting prognosis was evident (AUC _sAFP = 0.625, AUC _A/G/S-IHC = 0.723).

• More specificity (100%) with serum AFP level (especially > 1000 ng/mL) and more sensitivity (50%) with immunohistochemistry was achieved.