Clinicopathologic features and long-term results of alpha-fetoprotein-producing gastric cancer. During a 10-yr-period, 24 cases of alpha-fetoprotein-producing gastric cancer were experienced in our department. The mean age was 62.5 yr, and the sex ratio of males to females was 3:1. Borrmann II and III types of gastric cancer were predominant (83.3%). The prognosis was dismal. Most of the patients, including three radically operated cases of early gastric cancer, died from liver metastasis within 2 yr. The 1-, 3-, and 6-yr survival rates were 37.5%, 8.3%, and 8.3%, respectively, for all cases and 75.0%, 25.0%, and 25.0% for radically operated cases. The incidences of synchronous and metachronous liver metastasis were 31.8% and 40.9%, significantly higher than the incidences of AFP-negative gastric cancer (p less than 0.91). Despite radical gastrectomy, metachronous liver metastasis occurred in 75.0% of the cases. Two radical hepatic resections, including extended right lobectomy, were performed in one patient with early gastric cancer who had repeated metachronous liver metastasis. However, the tumor recurred immediately. Apparently, radical gastrectomy or hepatic resection alone may not suffice for this particular type of cancer. The methods of treatment and follow-up considered should be different from that for other types of gastric cancer. 