62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Hcc—90%肝外胆管细胞癌Hcc—10%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，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)Concept:alpha-fetoprotein-producinggastriccancer(AFPPGC)Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevelConceptofHAS1.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%1.AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.2.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.ConclusionWhy: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-up050100150200250300350400TimeCircularbloodAFPlevelRadicalsurgeryRadiofrequencytreatment2011-5-18术前2011-8-16MRI2012-1-92011.5.18上腹部CT增强：2011.8.16肝脏MRI增强：2012.1.19上腹部CT增强：2011年及2012初行PET-CTIschemotherapyneededinAFPGCatearlystage?Recommended!Thankyou!