切换至 "中华医学电子期刊资源库"

中华普通外科学文献(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 376 -379. doi: 10.3877/cma.j.issn.1674-0793.2023.05.012

综述

甲胎蛋白在胃肝样腺癌中的作用机制及诊断预后研究进展
兰青, 熊枝繁(), 杨盛力   
  1. 430077 武汉,华中科技大学同济医学院附属梨园医院消化内科
    430022 武汉,华中科技大学同济医学院附属协和医院肿瘤中心
  • 收稿日期:2023-03-28 出版日期:2023-10-01
  • 通信作者: 熊枝繁

Progress on the role mechanism, diagnostic value and prognosis of alpha fetoprotein in hepatoid adenocarcinoma of the stomach

Qing Lan, Zhifan Xiong(), Shengli Yang   

  1. Department of Gastroenterology,Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, China
    Cancer Center of Xiehe Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China
  • Received:2023-03-28 Published:2023-10-01
  • Corresponding author: Zhifan Xiong
引用本文:

兰青, 熊枝繁, 杨盛力. 甲胎蛋白在胃肝样腺癌中的作用机制及诊断预后研究进展[J]. 中华普通外科学文献(电子版), 2023, 17(05): 376-379.

Qing Lan, Zhifan Xiong, Shengli Yang. Progress on the role mechanism, diagnostic value and prognosis of alpha fetoprotein in hepatoid adenocarcinoma of the stomach[J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 376-379.

胃肝样腺癌(HAS)是一种罕见的恶性肿瘤,属于胃癌的特殊亚型,兼具腺癌和肝细胞癌样分化特征,且大部分患者血清甲胎蛋白(AFP)升高。作为肝癌的肿瘤标志物,AFP被广泛应用于临床,但其对于HAS的作用和价值还不明确。为进一步加深AFP在HAS中的认识并了解其临床意义,现就AFP在该病中的作用机制、诊断价值及预后关系等方面进行综述,以帮助临床医师准确诊治。

Hepatoid adenocarcinoma of the stomach (HAS) is a special subtype of gastric cancer, which is a rare malignant tumor with both adenocarcinoma and hepatocellular carcinoma-like differentiation, and most patients have elevated serum alpha fetoprotein (AFP). However, the value of AFP in HAS is still unclear. In order to further deepen the comprehensive understanding of AFP in HAS and to understand its clinical significance, the role mechanism, diagnostic value and prognosis of AFP are reviewed for accurate diagnosis and treatment of HAS in clinics.

表1 各文献中报道的AFP在胃肝样腺癌中的表达阳性率(%)
图1 AFP促进HAS发生发展可能的作用机制 左上部分:AFP通过抑制PTEN活性,激活PI3K/AKT/mTOR通路,促进src和ras表达,AFP还可作用于肿瘤细胞AFPR激活cAMP-PKA通路,Ca2+内流增多,进一步促进癌基因c-fos、c-jun和n-ras的表达,从而刺激肿瘤细胞增殖;右上部分:Wnt与细胞表面特异性受体作用激活DVL,DVL下调糖原合成激酶-3蛋白和轴蛋白复合体的降解活性,引起β-catenin堆积,β-catenin进入细胞核,调节基因表达,导致肿瘤发生;下半部分:AFP通过抑制效应T细胞的分化,同时激活调节T细胞扩增,还可抑制树突状细胞分泌IL-12,从而下调自然杀伤细胞的表达,进而抑制细胞免疫
[1]
Xia R, Zhou Y, Wang Y, et al. Hepatoid adenocarcinoma of the stomach: current perspectives and new developments[J]. Front Oncol, 2021, 11: 633916.
[2]
Meng W, Bai B, Bai Z, et al. The immunosuppression role of alpha-fetoprotein in human hepatocellular carcinoma[J]. Discov Med, 2016, 21(118): 489-494.
[3]
Zhang C, Zhang J, Wang J, et al. Alpha-fetoprotein accelerates the progression of hepatocellular carcinoma by promoting Bcl-2 gene expression through an RA-RAR signalling pathway[J]. J Cell Mol Med, 2020, 24(23): 13804-13812.
[4]
Bourreille J, Metayer P, Sauger F, et al. Existence of alpha feto protein during gastric-origin secondary cancer of the liver[J]. Presse Med (1893), 1970, 78(28): 1277-1278.
[5]
Ishikura H, Fukasawa Y, Ogasawara K, et al. An AFP-producing gastric carcinoma with features of hepatic differentiation. A case report[J]. Cancer, 1985, 56(4): 840-848.
[6]
Zhang Y, Han S, Lv L, et al. Case report: A rare case of hepatoid adenocarcinoma in stomach and duodenum simultaneously[J]. Cancer Manag Res, 2022, 14: 2185-2191.
[7]
Zhou Q, Zhou Y, Ouyang Y, et al. Hepatoid adenocarcinoma of the stomach with metastatic choriocarcinoma of the liver: A case report of a rare subtype of gastric cancer with a complex treatment course[J]. Front Surg, 2022, 9: 968891.
[8]
Osada M, Aishima S, Hirahashi M, et al. Combination of hepatocellular markers is useful for prognostication in gastric hepatoid adenocarcinoma[J]. Hum Pathol, 2014, 45(6): 1243-1250.
[9]
王祥旭, 潘伟, 博伦, 等. 35例胃肝样腺癌的临床病理观察[J]. 临床肿瘤学杂志, 2021, 26(3): 243-247.
[10]
赵荣飞, 王鑫鑫, 蓝忻, 等. 胃肝样腺癌临床病理特征及预后分析[J]. 中华胃肠外科杂志, 2017, 20(9): 1035-1039.
[11]
任为正, 苏茂生, 杜晓霞, 等. 胃肝样腺癌25例[J]. 中华肝胆外科杂志, 2016, 22(10): 665-667.
[12]
Liu XM, Chen GQ, Li SL, et al. Hepatoid adenocarcinoma of the stomach: A case report and literature review[J]. Exp Ther Med, 2015, 9(6): 2133-2136.
[13]
Su JS, Chen YT, Wang RC, et al. Clinicopathological characteristics in the differential diagnosis of hepatoid adenocarcinoma: A literature review[J]. World J Gastroenterol, 2013, 19(3): 321-327.
[14]
张琛琛, 于伟华, 杜亚婷, 等. 胃肝样腺癌的临床病理特点及预后分析[J]. 中国现代普通外科进展, 2022, 25(7): 543-547.
[15]
Wang Y, Sun L, Li Z, et al. Hepatoid adenocarcinoma of the stomach: A unique subgroup with distinct clinicopathological and molecular features[J]. Gastric Cancer, 2019, 22(6): 1183-1192.
[16]
Chen EB, Wei YC, Liu HN, et al. Hepatoid adenocarcinoma of stomach: emphasis on the clinical relationship with alpha-fetoprotein-positive gastric cancer[J]. Biomed Res Int, 2019, 2019: 6710428.
[17]
Inoue M, Sano T, Kuchiba A, et al. Long-term results of gastrectomy for alpha-fetoprotein-producing gastric cancer[J]. Br J Surg, 2010, 97(7): 1056-1061.
[18]
Lin JX, Wang ZK, Hong QQ, et al. Assessment of clinicopathological characteristics and development of an individualized prognostic model for patients with hepatoid adenocarcinoma of the stomach[J]. JAMA Netw Open, 2021, 4(10): e2128217.
[19]
邵国益, 张献, 胡根, 等. AFP阳性胃肝样腺癌15例临床分析[J]. 现代肿瘤医学, 2015, 23(21): 3154-3157.
[20]
李晨, 夏绍友, 张勇. 胃肝样腺癌血清甲胎蛋白阳性的临床意义[J]. 中国医药导报, 2012, 9(6): 43-45, 48.
[21]
Lin Y, Yang Y, Li W, et al. Reciprocal regulation of Akt and Oct4 promotes the self-renewal and survival of embryonal carcinoma cells[J]. Mol Cell, 2012, 48(4): 627-640.
[22]
Zhao QW, Zhou YW, Li WX, et al. Akt-mediated phosphorylation of Oct4 is associated with the proliferation of stem-like cancer cells[J]. Oncol Rep, 2015, 33(4): 1621-1629.
[23]
Zhu M, Guo J, Li W, et al. HBx induced AFP receptor expressed to activate PI3K/AKT signal to promote expression of Src in liver cells and hepatoma cells[J]. BMC Cancer, 2015, 15: 362.
[24]
Li MS, Li PF, He SP, et al. The promoting molecular mechanism of alpha-fetoprotein on the growth of human hepatoma Bel7402 cell line[J]. World J Gastroenterol, 2002, 8(3): 469-475.
[25]
Li M, Mei YX, Wen JH, et al. Hepatoid adenocarcinoma-clinicopathological features and molecular characteristics[J]. Cancer Lett, 2023, 559: 216104.
[26]
Gálvez-Muñoz E, Gallego-Plazas J, Gonzalez-Orozco V, et al. Hepatoid adenocarcinoma of the stomach - a different histology for not so different gastric adenocarcinoma: A case report[J]. Int Semin Surg Oncol, 2009, 6: 13.
[27]
陆泳言, 姜文凯, 李硕, 等. 甲胎蛋白阳性胃癌的分子机制与诊疗现状[J]. 临床与病理杂志, 2022, 42(9): 2255-2261.
[28]
Rajasekaran P, Pattnaik B, Mishra M, et al. Alpha-fetoprotein (AFP)-negative hepatoid adenocarcinoma of the stomach and its associated uncommon features with a review[J]. Int J Surg Pathol, 2022: 10668969221142038.
[29]
Nagai E, Ueyama T, Yao T, et al. Hepatoid adenocarcinoma of the stomach. A clinicopathologic and immunohistochemical analysis[J]. Cancer, 1993, 72(6): 1827-1835.
[30]
于丽丽, 何向蕾, 吴建宇, 等. GPC3、HSP70、SALL4和AFP联合表达对胃肝样腺癌诊断的意义[J]. 浙江医学, 2020, 42(8): 780-782, 786, 884.
[31]
刘鑫, 温宗华, 张国, 等. 胃肝样腺癌6例临床资料分析[J]. 临床消化病杂志, 2017, 29(3): 155-158.
[32]
Metzgeroth G, Ströbel P, Baumbusch T, et al. Hepatoid adenocarcinoma-review of the literature illustrated by a rare case originating in the peritoneal cavity[J]. Onkologie, 2010, 33(5): 263-269.
[33]
Chen Y, Qu H, Jian M, et al. High level of serum AFP is an independent negative prognostic factor in gastric cancer[J]. Int J Biol Markers, 2015, 30(4): e387-e393.
[34]
Lin HJ, Hsieh YH, Fang WL, et al. Clinical manifestations in patients with alpha-fetoprotein-producing gastric cancer[J]. Curr Oncol, 2014, 21(3): e394-e399.
[35]
He F, Fu Y, Sun Q, et al. Integrated clinicopathological and immunohistochemical analysis of gastric adenocarcinoma with hepatoid differentiation: An exploration of histogenesis, molecular characteristics, and prognostic markers[J]. Hum Pathol, 2021, 115: 37-46.
[1] 杨水华, 何桂丹, 覃桂灿, 梁蒙凤, 罗艳合, 李雪芹, 唐娟松. 胎儿孤立性完全型肺静脉异位引流的超声心动图特征及高分辨率血流联合时间-空间相关成像的应用[J]. 中华医学超声杂志(电子版), 2023, 20(10): 1061-1067.
[2] 彭旭, 邵永孚, 李铎, 邹瑞, 邢贞明. 结肠肝曲癌的诊断和外科治疗[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 108-110.
[3] 马伟强, 马斌林, 吴中语, 张莹. microRNA在三阴性乳腺癌进展中发挥的作用[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 111-114.
[4] 杨倩, 李翠芳, 张婉秋. 原发性肝癌自发性破裂出血急诊TACE术后的近远期预后及影响因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 33-36.
[5] 栗艳松, 冯会敏, 刘明超, 刘泽鹏, 姜秋霞. STIP1在三阴性乳腺癌组织中的表达及临床意义研究[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 52-56.
[6] 潘冰, 吕少诚, 赵昕, 李立新, 郎韧, 贺强. 淋巴结清扫数目对远端胆管癌胰十二指肠切除手术疗效的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 608-612.
[7] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[8] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[9] 许丁伟, 马江云, 李新成, 黄洁. Alagille综合征疑诊为先天性胆道闭锁一例并文献复习[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 681-687.
[10] 李永胜, 孙家和, 郭书伟, 卢义康, 刘洪洲. 高龄结直肠癌患者根治术后短期并发症及其影响因素[J]. 中华临床医师杂志(电子版), 2023, 17(9): 962-967.
[11] 袁媛, 赵良平, 刘智慧, 张丽萍, 谭丽梅, 閤梦琴. 子宫内膜癌组织中miR-25-3p、PTEN的表达及与病理参数的关系[J]. 中华临床医师杂志(电子版), 2023, 17(9): 1016-1020.
[12] 王军, 刘鲲鹏, 姚兰, 张华, 魏越, 索利斌, 陈骏, 苗成利, 罗成华. 腹膜后肿瘤切除术中大量输血患者的麻醉管理特点与分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 844-849.
[13] 李田, 徐洪, 刘和亮. 尘肺病的相关研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(08): 900-905.
[14] 索利斌, 刘鲲鹏, 姚兰, 张华, 魏越, 王军, 陈骏, 苗成利, 罗成华. 原发性腹膜后副神经节瘤切除术麻醉管理的特点和分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 771-776.
[15] 周婷, 孙培培, 张二明, 安欣华, 向平超. 北京市石景山区40岁及以上居民慢性阻塞性肺疾病诊断现状调查[J]. 中华临床医师杂志(电子版), 2023, 17(07): 790-797.
阅读次数
全文


摘要