Objective We analyzed the clinical characteristics, survival of alpha-fetoprotein-producing gastric carcinoma (AFPGC) patients, and traditional Chinese medicine ( TCM) treatment on them to improve TCM clinicians′ recognition of AFPGC. Methods We retrospectively collected the clinical and survival characteristics of patients with gastric cancer who were pathologically diagnosed and treated with TCM from January 2012 to December 2018, including 46 patients with AFPGC and 363 patients with common gastric cancer, according to the eligibility criteria. To compare and analyze the survival of patients with different alpha-fetoprotein (AFP) levels, we performed COX multivariate analysis of the prognostic factors of AFPGC patients and an analysis of TCM treatment principles and prescriptions. Results AFPGC patients accounted for 4. 1% of all gastric cancers patients. Compared with common gastric cancer, the proportion of AFPGC was found to be higher in Uyghur and Kazakh patients than in Han patients (P<0. 001). AFPGC patients also showed marked invasion depths (P = 0. 032), higher ratio of lymphatic metastasis or distant metastasis(P = 0. 016, P < 0. 001), and had lower chances of receiving chemotherapy and surgery (P = 0. 018, P = 0. 001, respectively). The proportion of liver and peritoneal metastases was also higher in AFPGC patients (P<0. 001, each). The medium overall survival (mOS) of AFPGC patients was 11 (95% CI:7-14)months, while that for common gastric cancer was 33 (95% CI:26-45) months. AFPGC patients had a three-fold increased hazard ratio for death in common gastric cancer patients(HR = 3. 00, P<0. 001). The survival rates of AFPGC patients at 1, 3, and 5 years were 46. 7%, 11. 1%, and 2. 3%, lower, respectively, than that of the common gastric cancer patients (P<0. 001). We conducted subgroup analysis according to the level of AFP, < 20 μg / L, 20- 300 μg / L, and > 300 μg / L. The mOS of the three groups of patients was 33. 0, 14. 0, and 6. 5 months, and the difference was significant ( P < 0. 001 ). Radical surgery and AFP level were independent prognostic factors in AFPGC patients, and radical surgery could reduce the risk of death in AFPGC patients by 61. 2%. Patients with AFP >300 μg / L had a 1. 98-fold higher risk of death than patients with AFP 20-300 μg / L (P = 0. 029, P = 0. 048). The principles of TCM treatment include strengthening the spleen, replenishing qi, and removing phlegm from the stomach. We analyzed the frequency of antitumor TCM in the prescriptions of the patients at the first visit and found that the main drugs were used to strengthen vital qi and tonify. Conclusion AFPGC has unique clinical characteristics: poor biological behavior; prone to the liver, lymph node, and peritoneal metastasis; late-stage diagnosis; and a lower chance of receiving surgery and chemotherapy than ordinary gastric cancer. Survival is significantly worse than that of common gastric cancer and is significantly negatively correlated with AFP level. Radical resection is the only method that can improve the prognosis of AFPGC. Objective We analyzed the clinical characteristics, survival of alpha-fetoprotein-producing gastric carcinoma (AFPGC) patients, and traditional Chinese medicine ( TCM) treatment on them to improve TCM clinicians′ recognition of AFPGC. Methods We retrospectively collected the clinical and survival characteristics of patients with gastric cancer who were pathologically diagnosed and treated with TCM from January 2012 to December 2018, including 46 patients with AFPGC and 363 patients with common gastric cancer, according to the eligibility criteria. To compare and analyze the survival of patients with different alpha-fetoprotein (AFP) levels, we performed COX multivariate analysis of the prognostic factors of AFPGC patients and an analysis of TCM treatment principles and prescriptions. Results AFPGC patients accounted for 4. 1% of all gastric cancers patients. Compared with common gastric cancer, the proportion of AFPGC was found to be higher in Uyghur and Kazakh patients than in Han patients (P<0. 001). AFPGC patients also showed marked invasion depths (P = 0. 032), higher ratio of lymphatic metastasis or distant metastasis(P = 0. 016, P < 0. 001), and had lower chances of receiving chemotherapy and surgery (P = 0. 018, P = 0. 001, respectively). The proportion of liver and peritoneal metastases was also higher in AFPGC patients (P<0. 001, each). The medium overall survival (mOS) of AFPGC patients was 11 (95% CI:7-14)months, while that for common gastric cancer was 33 (95% CI:26-45) months. AFPGC patients had a three-fold increased hazard ratio for death in common gastric cancer patients(HR = 3. 00, P<0. 001). The survival rates of AFPGC patients at 1, 3, and 5 years were 46. 7%, 11. 1%, and 2. 3%, lower, respectively, than that of the common gastric cancer patients (P<0. 001). We conducted subgroup analysis according to the level of AFP, < 20 μg / L, 20- 300 μg / L, and > 300 μg / L. The mOS of the three groups of patients was 33. 0, 14. 0, and 6. 5 months, and the difference was significant ( P < 0. 001 ). Radical surgery and AFP level were independent prognostic factors in AFPGC patients, and radical surgery could reduce the risk of death in AFPGC patients by 61. 2%. Patients with AFP >300 μg / L had a 1. 98-fold higher risk of death than patients with AFP 20-300 μg / L (P = 0. 029, P = 0. 048). The principles of TCM treatment include strengthening the spleen, replenishing qi, and removing phlegm from the stomach. We analyzed the frequency of antitumor TCM in the prescriptions of the patients at the first visit and found that the main drugs were used to strengthen vital qi and tonify. Conclusion AFPGC has unique clinical characteristics: poor biological behavior; prone to the liver, lymph node, and peritoneal metastasis; late-stage diagnosis; and a lower chance of receiving surgery and chemotherapy than ordinary gastric cancer. Survival is significantly worse than that of common gastric cancer and is significantly negatively correlated with AFP level. Radical resection is the only method that can improve the prognosis of AFPGC. [ABSTRACT FROM AUTHOR]