肝样胃癌的临床病理特征、预后及研究展望课件

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）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，Ⅲ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)ConceptofHAS1.Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingmorphologicalareasidenticaltothatofhepatocellularcarcinomas.2.Inadditiontothehistologicalsimilarity,itcanalsoproduceAFP-likehepatocellularcarcinomasPatientsCharacteristicsNoCorrelationAnalysis我们科室AFPPGC与对照胃癌患者的总生存比较49.2%11.5%75.6%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)2011-5-18术前2011-8-16MRI2012-1-92011.5.18上腹部CT增强：2011.8.16肝脏MR