肝样胃癌的临床病理特征预后及研究展望优质案例课件.ppt

1、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（优选）肝样胃癌的临床病理特征预后及研究展望研究展望新生幼稚肝细胞（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增高增高肝细胞癌Hcc90%肝外胆管细胞癌Hcc10%原发性肝癌v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!v 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。v 同时发现约20%的晚期肝癌病人，直至病故前，AFP仍不超过10。v AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。v A

2、FP也与病理类型相关，癌细胞分化I级和II级，AFP相对较低，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 急性肝炎急性肝炎慢性肝炎慢性肝炎肝硬化肝硬化孕妇;其他肿瘤的肝转移一过性升高随着病情的恢复，血清

3、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 of HASWhy:HAS means poor prognosis?肝样胃癌的临床病理特征预后及研究展望Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?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

4、恶化它在血清中的含量会急剧增加肝细胞癌Hcc90%Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.（优选）肝样胃癌的临床病理特征预后及研究展望肝细胞癌Hcc90%!EXCEPTION!Patients Characteristics随着病情的恢复，血清甲胎蛋白值会下降Can AFP be acted as a biomarker of poor prognosis a

5、nd chemotherapy in gastric cancer?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。In addition to the histological similarity,it can also produceWhy:HAS means poor prognosis?Concept:alpha-fetoprotein-producing gastric cancer(AFPPGC)At present time,it was generally accepted that the diagnostic criteria of AFP-

6、producing gastric cancer was positive staining of AFP in primary lesion regardless of serum AFP levelConcept of HAS 1.Hepatoid adenocarcinoma is a kind of extrahepatic tumor presentingmorphological areas identical to that of hepatocellular carcinomas.2.In addition to the histological similarity,it c

7、an also produceAFP-like hepatocellular carcinomasPatients CharacteristicsNo Correlation AnalysisAFP也与病理类型相关，癌细胞分化I级和II级，AFP相对较低，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Amemiya et al.HAS irrespective of AFP production have a poorer prognosis than AFP-producin

8、g gastric carcinomas without hepatoid differentiationHAS should be distinguished from AFPPGC.It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.Target gene of poor biological behavior and easy to liver metast

9、asis?Target gene of poor biological behavior and easy to liver metastasis?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-producing gastric cancer(AFPPGC)One Case(ID:1204170)At present time,it was generally accepted that the diagnostic criteria of AFP-producing gastric cancer was positive staining

10、 of AFP in primary lesion regardless of serum AFP levelConcept of HAS!EXCEPTION!随着病情的恢复，血清甲胎蛋白值会下降肝癌One Case(ID:1204170)The exact molecular mechanism that could explain aggressive behavior was still not clear.Can AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer?我们科室我们

11、科室AFPPGC与对照胃癌患者的总生存比较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.Conclusi

12、onWhy:HAS means poor prognosis?v It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.v The exact molecular mechanism that could explain aggressive behavior was still not clear.Some previous researches showed t

13、hat 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 in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.These results su

14、ggested that aggressive behavior of AFP-producing gastric cancer may be associated with over-expressed c-Met.Target gene of poor biological behavior and easy to liver metastasis?AFP in clinical use:v Can AFP be routinely checked in circular blood and gastric tissues by IHC?v Can AFP be acted as a bi

15、omarker of poor prognosis and chemotherapy in gastric cancer?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It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.alpha-fetoprotein-producing gastric cancer(AFPGC)Found that c-Me

16、t over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.One Case(ID:1204170)Hepatoid adenocarcinoma of the stomach(HAS)我们科室AFPPGC与对照胃癌患者的总生存比较HAS irrespective of AFP production have a poorer prognosis than AFP-producing gastric carc

17、inomas without hepatoid differentiationHAS should be distinguished from AFPPGC.It was proposed that some secretory proteins like AFP had immunosuppressive and protease-inhibitory properties,therefore enhanced invasiveness.肝外胆管细胞癌Hcc10%No Correlation AnalysisTarget gene of poor biological behavior an

18、d easy to liver metastasis?alpha-fetoprotein-producing gastric cancer(AFPGC)80-90%Hcc患者血清AFP增高肝癌细胞Hepatoid adenocarcinoma is a kind of extrahepatic tumor presentingAFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。Hepatoid adenocarcinoma of the stomach(HAS)One Case(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Amemiya et al.肝

19、外胆管细胞癌Hcc10%甲胎蛋白是诊断原发性肝癌的一个特异性临床指标。Hepatoid adenocarcinoma is a kind of extrahepatic tumor presentingalpha-fetoprotein-producing gastric cancer(AFPPGC)AFP与肿瘤大小有一定的相关性，即肿瘤越小，阳性率越低。Concept of HASalpha-fetoprotein-producing gastric cancer(AFPGC)肝细胞癌Hcc90%Can AFP be acted as a biomarker of poor prognosi

20、s and chemotherapy in gastric cancer?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 levelCan AFP be acted as a biomarker of poor prognosis and chemotherapy in gastric cancer

21、?!EXCEPTION!肝癌Found that c-Met over-expressed frequently in AFP-producing gastric cancers than in stage-matched gastric cancers that did not produce AFP.Amemiya et al.（优选）肝样胃癌的临床病理特征预后及研究展望One Case(ID:1204170)v Female,51yv 外院胃镜病理我院会诊意见：（胃窦小弯）腺癌v 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v AFPPGC(IHC)