肝样胃癌的临床病理特征、预后及研究展望教学教案.pptVIP

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。 Some reports showed that AFP could also be produced by gastrointestinal tract organs, rectal carcinoma, gallbladder carcinoma, lung carcinoma, and bladder cancer. 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-producing gastric cancer (AFPGC) Hepatoid adenocarcinoma of the stomach (HAS) Concept: alpha-fetoprotein-producing gastric cancer (AFPPGC) At present time, it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP level Concept of HAS 1. Hepatoid adenocarcinoma is a kind of extrahepatic tumor presenting morphological areas identical to that of hepatocellular carcinomas. 2. In addition to the histological similarity, it can also produce AFP-like hepatocellular carcinomas Patients Characteristics No Correlation Analysis 我们科室AFPPGC与对照胃癌患者的总生存比较 49.2% 11.5% 75.6% AFPPGC and HAS had more aggressive behavior and poorer prognosis than CGC. HAS irrespective of AFP production have a poorer prognosis than AFP-producing gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC. Conclusion Why: HAS means poor prognosis? It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties, therefore enhanced invasiveness. The exact molecular mechanism that could explain aggressive behavior was still not clear. Some previous researches showed that the integrity of hepatocyte growth factor (HGF) receptor (c-Met) and ligand as HGF could regulate cell proliferation and migration. Amemiya et al. Found that c-Met over-expressed frequently