肝樣胃癌的臨床病理特征、預(yù)后及研究展望

1、肝樣胃癌的臨床病理特征、預(yù)后及研究展望,AFP,甲種胎兒球蛋白，甲型胎兒蛋白糖蛋白,正常情況下，來自胚胎的肝細(xì)胞和卵黃囊。,胎兒出生約兩周后甲胎蛋白從血液中消失。,正常人血清中甲胎蛋白的含量尚不到20微克／升。,新生幼稚肝細(xì)胞（未分化完全）,分泌AFP量很大,肝癌細(xì)胞（尚未分化的肝細(xì)胞）,,,,80-90%Hcc患者血清AFP增高,,,肝細(xì)胞癌Hcc—90%,肝外膽管細(xì)胞癌Hcc—10%,原發(fā)性肝癌,,甲胎蛋白是診斷原發(fā)性肝癌的一個(gè)

2、特異性臨床指標(biāo)。,However,!!EXCEPTION!!,!!EXCEPTION!!,部分肝硬化病人會(huì)長期出現(xiàn)AFP達(dá)到上千，但多年都沒有肝癌的跡象。同時(shí)發(fā)現(xiàn)約20%的晚期肝癌病人，直至病故前，AFP仍不超過10。 AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽性率越低。AFP也與病理類型相關(guān)，癌細(xì)胞分化I級和II級，AFP相對較低，Ⅲ級時(shí)相對較高。,Some reports showed that AFP could als

3、o be produced by gastrointestinal tract organs, rectal carcinoma, gallbladder carcinoma, lung carcinoma, and bladder cancer.,血清甲胎蛋白增高的原因,肝癌（陽性率80-90%）,隨著病情惡化它在血清中的含量會(huì)急劇增加,急性肝炎慢性肝炎肝硬化,孕婦;其他腫瘤的肝轉(zhuǎn)移,一過性升高隨著病情的恢復(fù)，血清甲胎蛋白值

4、會(huì)下降,生殖細(xì)胞腫瘤陽性率50%,AFP陽性,,,,,,,alpha-fetoprotein-producing gastric cancer (AFPGC),Hepatoid adenocarcinoma of the stomach (HAS),Concept: alpha-fetoprotein-producing gastric cancer (AFPPGC),At present time, it was general

5、ly accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP level,Concept of HAS,1. Hepatoid adenocarcinoma is a kind of extrahepatic tu

6、mor presentingmorphological areas identical to that of hepatocellular carcinomas.,2. In addition to the histological similarity, it can also produceAFP-like hepatocellular carcinomas,,Patients Characteristics,No Correl

7、ation Analysis,我們科室AFPPGC與對照胃癌患者的總生存比較,,,,,,,,,49.2%,11.5%,75.6%,AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC. HAS irrespective of AFP production have a poorer prognosis than AFP-producing

8、gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.,Conclusion,Why: HAS means poor prognosis?,It was proposed that some secretory proteins like AFP had immunosuppressive and protea

9、se-inhibitory properties, therefore enhanced invasiveness.The exact molecular mechanism that could explain aggressive behavior was still not clear. Some previous researches showed that the integrity of hepatocyte growth

10、 factor (HGF) receptor (c-Met) and ligand as HGF could regulate cell proliferation and migration. Amemiya et al. Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric

11、cancers that did not produce AFP. These results suggested that aggressive behavior of AFP-producing gastric cancer may be associated with over-expressed c-Met.,Target gene of poor biological behavior and easy to liver me

12、tastasis?,AFP in clinical use:,Can AFP be routinely checked in circular blood and gastric tissues by IHC? Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?,One Case (ID:1204170),Fema

13、le, 51y外院胃鏡病理我院會(huì)診意見：（胃竇小彎）腺癌術(shù)后病理（2010-5-25）：遠(yuǎn)端胃大部切除標(biāo)本，IIc型，高-中分化腺癌，浸潤至粘膜下層（早期胃癌），未見淋巴結(jié)轉(zhuǎn)移（0/25），切緣陰性AFPPGC (IHC),AFP level changement in follow-up,0,50,100,150,200,250,300,350,400,2010年5月,2010年8月,2010年11月,2011年2月,20

14、11年5月,2011年8月,2011年11月,2012年2月,2012年5月,2012年8月,2012年11月,2013年2月,Time,Circular blood AFP level,,Radical surgery,,Radiofrequency treatment,2011-5-18 術(shù)前,2011-8-16 MRI,2012-1-9,2011.5.18 上腹部CT增強(qiáng)：,2011.8.16 肝臟MRI增強(qiáng)：,2012.1.19