AUTHOR: Xue-Ru Zhu, MD, MSa, Mei-Ling Zhu, MD, PhDa, Qing Wang, MD, MSa, Wen-Ji Xue, MD, MSa,
Yi-Wei Wang, MD, MSa, Rui-Fen Wang, MD, MSb, Si-Yu Chen, MD, PhDa, Lei-Zhen Zheng, MD, PhDa,∗

SOURCE: Medicine

Abstract
Background: Alpha-fetoprotein (AFP) is an important marker for hepatocellular carcinoma, and the detection of serum AFP is
currently the principle method for the diagnosis of hepatocellular carcinoma. The prevalence of gastric cancer (GC) with high level of
serum AFP is extremely rare, but has unique clinical features.
Case summary: We herein present a rare case with GC and high level of serum AFP. A 64-year-old Chinese female underwent
gastrectomy was diagnosed as gastric adenocarcinoma and the pathological stage was T1bN0M0, IA. With the progression of
disease, the tumor widely metastasized and the serum AFP level increased progressively with the highest level of 3396ng/mL. She
successively entered into 3 lines palliative systematic chemotherapy and fourth-line targeted therapy of apatinib, a small molecule
tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2. Although previous studies suggested that the
prognosis of this special type of GC was poor, this patient lived for 22 months after tumor transfer. Apatinib kept her progression-free
survival for 5 months, and the overall survival was 4.5 years.