肝样胃癌的临床病理特征预后及研究展望优质案例课件

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1（优选）肝样胃癌的临床病理特征预后及研究展望（优选）肝样胃癌的临床病理特征预后及研究展望2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）新生幼稚肝细胞分泌AFP量很大380-90%Hcc患者血清AFP增高肝细胞癌Hcc—90%肝外胆管细胞癌Hcc—10%原发性肝癌80-90%Hcc患者血清AFP增高肝细胞癌Hcc—90%肝4甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。However!!EXCEPTION!!甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。Howeve5!!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.!!EXCEPTION!!部分肝硬化病人会长期出现AFP达到6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阳性血清甲胎蛋白增高的原因7alpha-fetoprotein-producinggastriccancer(AFPGC)Hepatoidadenocarcinomaofthestomach(HAS)alpha-fetoprotein-producingga8ConceptofHASWhy:HASmeanspoorprognosis?肝样胃癌的临床病理特征预后及研究展望CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。随着病情恶化它在血清中的含量会急剧增加肝细胞癌Hcc—90%Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.（优选）肝样胃癌的临床病理特征预后及研究展望肝细胞癌Hcc—90%!!EXCEPTION!!PatientsCharacteristics随着病情的恢复，血清甲胎蛋白值会下降CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?血清甲胎蛋白增高的原因AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。Inadditiontothehistologicalsimilarity,itcanalsoproduceWhy:HASmeanspoorprognosis?Concept:

alpha-fetoprotein-producinggastriccancer(AFPPGC)Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevelConceptofHASConcept:Atprese9ConceptofHAS1.Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingmorphologicalareasidenticaltothatofhepatocellularcarcinomas.2.Inadditiontothehistologicalsimilarity,itcanalsoproduceAFP-likehepatocellularcarcinomasConceptofHAS1.Hepatoidade10肝样胃癌的临床病理特征预后及研究展望优质案例课件11PatientsCharacteristicsPatientsCharacteristics12肝样胃癌的临床病理特征预后及研究展望优质案例课件13NoCorrelationAnalysisNoCorrelationAnalysis14肝样胃癌的临床病理特征预后及研究展望优质案例课件15AFP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。肝癌肝癌术后病理（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Amemiyaetal.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。alpha-fetoprotein-producinggastriccancer(AFPPGC)OneCase(ID:1204170)Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevelConceptofHAS!!EXCEPTION!!随着病情的恢复，血清甲胎蛋白值会下降肝癌OneCase(ID:1204170)Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?我们科室AFPPGC与对照胃癌患者的总生存比较AFP也与病理类型相关，癌细胞分化I级和II级，AFP相对较16肝样胃癌的临床病理特征预后及研究展望优质案例课件17肝样胃癌的临床病理特征预后及研究展望优质案例课件18肝样胃癌的临床病理特征预后及研究展望优质案例课件19肝样胃癌的临床病理特征预后及研究展望优质案例课件20肝样胃癌的临床病理特征预后及研究展望优质案例课件21肝样胃癌的临床病理特征预后及研究展望优质案例课件2249.2%11.5%75.6%49.2%11.5%75.6%23肝样胃癌的临床病理特征预后及研究展望优质案例课件24AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.ConclusionAFPPGCandHAShadmoreaggres25Why:HASmeanspoorprognosis?ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.Amemiyaetal.Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.TheseresultssuggestedthataggressivebehaviorofAFP-producinggastriccancermaybeassociatedwithover-expressedc-Met.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?Why:HASmeanspoorprognosis?26AFPinclinicaluse:CanAFPberoutinelycheckedincircularbloodandgastrictissuesbyIHC?CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?AFPinclinicaluse:CanAFP27外院胃镜病理我院会诊意见：（胃窦小弯）腺癌血清甲胎蛋白增高的原因ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.alpha-fetoprotein-producinggastriccancer(AFPGC)Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.OneCase(ID:1204170)Hepatoidadenocarcinomaofthestomach(HAS)我们科室AFPPGC与对照胃癌患者的总生存比较HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.肝外胆管细胞癌Hcc—10%NoCorrelationAnalysisTargetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?alpha-fetoprotein-producinggastriccancer(AFPGC)80-90%Hcc患者血清AFP增高肝癌细胞HepatoidadenocarcinomaisakindofextrahepatictumorpresentingAFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。Hepatoidadenocarcinomaofthestomach(HAS)OneCase(ID:1204170)血清甲胎蛋白增高的原因随着病情恶化它在血清中的含量会急剧增加Amemiyaetal.肝外胆管细胞癌Hcc—10%甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingalpha-fetoprotein-producinggastriccancer(AFPPGC)AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。ConceptofHASalpha-fetoprotein-producinggastriccancer(AFPGC)肝细胞癌