In a 2014 systematic review by the Task Force of the Japanese Gastric Cancer Association, Shimada et al. found elevated CA19-9 to have a positive predictive value of 78-96% for the presence of lymph node metastasis, while elevated CA-125 and AFP were noted to be associated with peritoneal and liver metastasis, respectively [11]. This evidence concerns the gene AFP and metastatic malignant neoplasm in the lymph nodes.