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。,SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.,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-producinggastriccancer(AFPGC),Hepatoidadenocarcinomaofthestomach(HAS),Concept:alpha-fetoprotein-producinggastriccancer(AFPPGC),Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevel,ConceptofHAS,1.Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingmorphologicalareasidenticaltothatofhepatocellularcarcinomas.,2.Inadditiontothehistologicalsimilarity,itcanalsoproduceAFP-likehepatocellularcarcinomas,PatientsCharacteristics,NoCorrelationAnalysis,我们科室AFPPGC与对照胃癌患者的总生存比较,49.2%,11.5%,75.6%,AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.,Conclusion,Why:HASmeanspoorprognosis?,ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.Amemiyaetal.Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.TheseresultssuggestedthataggressivebehaviorofAFP-producinggastriccancermaybeassociatedwithover-expressedc-Met.,Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?,AFPinclinicaluse:,CanAFPberoutinelycheckedincircularbloodandgastrictissuesbyIHC?CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?,OneCase(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),AFPlevelchangementinfollow-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,CircularbloodAFPlevel,Radicalsurgery,Radiofrequencytreatment,2011-5-18术前,2011-8-16MRI,2012