肝樣胃癌的臨床病理特征預(yù)后及研究展望演示文稿

肝樣胃癌的臨床病理特征預(yù)后及研究展望演示文稿當前第1頁\共有28頁\編于星期三\13點（優(yōu)選）肝樣胃癌的臨床病理特征預(yù)后及研究展望當前第2頁\共有28頁\編于星期三\13點新生幼稚肝細胞（未分化完全）分泌AFP量很大

肝癌細胞（尚未分化的肝細胞）當前第3頁\共有28頁\編于星期三\13點80-90%Hcc患者血清AFP增高肝細胞癌Hcc—90%肝外膽管細胞癌Hcc—10%原發(fā)性肝癌當前第4頁\共有28頁\編于星期三\13點甲胎蛋白是診斷原發(fā)性肝癌的一個特異性臨床指標。However!!EXCEPTION!!當前第5頁\共有28頁\編于星期三\13點!!EXCEPTION!!部分肝硬化病人會長期出現(xiàn)AFP達到上千，但多年都沒有肝癌的跡象。同時發(fā)現(xiàn)約20%的晚期肝癌病人，直至病故前，AFP仍不超過10。

AFP與腫瘤大小有一定的相關(guān)性，即腫瘤越小，陽性率越低。AFP也與病理類型相關(guān)，癌細胞分化I級和II級，AFP相對較低，Ⅲ級時相對較高。SomereportsshowedthatAFPcouldalsobeproducedbygastrointestinaltractorgans,rectalcarcinoma,gallbladdercarcinoma,lungcarcinoma,andbladdercancer.當前第6頁\共有28頁\編于星期三\13點血清甲胎蛋白增高的原因

肝癌（陽性率80-90%）隨著病情惡化它在血清中的含量會急劇增加

急性肝炎慢性肝炎肝硬化孕婦;其他腫瘤的肝轉(zhuǎn)移一過性升高隨著病情的恢復，血清甲胎蛋白值會下降

生殖細胞腫瘤陽性率50%AFP陽性當前第7頁\共有28頁\編于星期三\13點alpha-fetoprotein-producinggastriccancer(AFPGC)Hepatoidadenocarcinomaofthestomach(HAS)當前第8頁\共有28頁\編于星期三\13點Concept:

alpha-fetoprotein-producinggastriccancer(AFPPGC)Atpresenttime,itwasgenerallyacceptedthatthediagnosticcriteriaofAFP-producinggastriccancerwaspositivestainingofAFPinprimarylesionregardlessofserumAFPlevel當前第9頁\共有28頁\編于星期三\13點ConceptofHAS1.Hepatoidadenocarcinomaisakindofextrahepatictumorpresentingmorphologicalareasidenticaltothatofhepatocellularcarcinomas.2.Inadditiontothehistologicalsimilarity,itcanalsoproduceAFP-likehepatocellularcarcinomas當前第10頁\共有28頁\編于星期三\13點當前第11頁\共有28頁\編于星期三\13點PatientsCharacteristics當前第12頁\共有28頁\編于星期三\13點當前第13頁\共有28頁\編于星期三\13點NoCorrelationAnalysis當前第14頁\共有28頁\編于星期三\13點當前第15頁\共有28頁\編于星期三\13點我們科室AFPPGC與對照胃癌患者的總生存比較當前第16頁\共有28頁\編于星期三\13點當前第17頁\共有28頁\編于星期三\13點當前第18頁\共有28頁\編于星期三\13點當前第19頁\共有28頁\編于星期三\13點當前第20頁\共有28頁\編于星期三\13點當前第21頁\共有28頁\編于星期三\13點當前第22頁\共有28頁\編于星期三\13點49.2%11.5%75.6%當前第23頁\共有28頁\編于星期三\13點當前第24頁\共有28頁\編于星期三\13點AFPPGCandHAShadmoreaggressivebehaviorandpoorerprognosisthanCGC.HASirrespectiveofAFPproductionhaveapoorerprognosisthanAFP-producinggastriccarcinomaswithouthepatoiddifferentiationHASshouldbedistinguishedfromAFPPGC.Conclusion當前第25頁\共有28頁\編于星期三\13點Why:HASmeanspoorprognosis?ItwasproposedthatsomesecretoryproteinslikeAFPhadimmunosuppressiveandprotease-inhibitoryproperties,thereforeenhancedinvasiveness.Theexactmolecularmechanismthatcouldexplainaggressivebehaviorwasstillnotclear.Somepreviousresearchesshowedthattheintegrityofhepatocytegrowthfactor(HGF)receptor(c-Met)andligandasHGFcouldregulatecellproliferationandmigration.Amemiyaetal.Foundthatc-Metover-expressedfrequentlyinAFP-producinggastriccancersthaninstage-matchedgastriccancersthatdidnotproduceAFP.TheseresultssuggestedthataggressivebehaviorofAFP-producinggastriccancermaybeassociatedwithover-expressedc-Met.Targetgeneofpoorbiologicalbehaviorandeasytolivermetastasis?當前第26頁\共有28頁\編于星期三\13點AFPinclinicaluse:

CanAFPberoutinelycheckedincircularbloodandgastrictissuesbyIHC?CanAFPbeactedasabiomarkerofpoorprognosisandchemotherapyingastriccancer?當前第27頁\共有28頁\編于星期三\13點O