肝样胃癌的临床病理特征预后及研究展望

肝样胃癌的临床病理特征、预后及研究展望,AFP,甲种胎儿球蛋白，甲型胎儿蛋白糖蛋白,正常情况下，来自胚胎的肝细胞和卵黄囊。,胎儿出生约两周后甲胎蛋白从血液中消失。,正常人血清中甲胎蛋白的含量尚不到20微克升。,新生幼稚肝细胞（未分化完全）,分泌AFP量很大,肝癌细胞（尚未分化的肝细胞）,80-90%Hcc患者血清AFP增高,肝细胞癌Hcc90%,肝外胆管细胞癌Hcc10%,原发性肝癌,甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。,However,!EXCEPTION!,!EXCEPTION!,部分肝硬化病人会长期出现AFP达到上千，但多年都没有肝癌的迹象。同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。 AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。AFP也与病理类型相关，癌细胞分化I级和II级，AFP相对较低，级时相对较高。,Some reports showed that AFP could also 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（阳性率80-90%）,随着病情恶化它在血清中的含量会急剧增加,急性肝炎慢性肝炎肝硬化,孕妇;其他肿瘤的肝转移,一过性升高随着病情的恢复，血清甲胎蛋白值会下降,生殖细胞肿瘤阳性率50%,AFP阳性,alpha-fetoprotein-producing gastric cancer (AFPGC),Hepatoid adenocarcinoma of the stomach (HAS),Concept: alpha-fetoprotein-producing gastric cancer (AFPPGC),At present time, it was generally 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 tumor 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 Correlation Analysis,我们科室AFPPGC与对照胃癌患者的总生存比较,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 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 protease-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 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 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 metastasis?,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),Female, 51y外院胃镜病理我院会诊意见：（胃窦小弯）腺癌术后病理（2010-5-25）：远端胃大部切除标本，IIc型，高-中分化腺癌，浸润至粘膜下层（早期胃癌），未见淋巴结转移（0/25），切缘阴性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,2011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 术前,2011-8-16 MRI,2