Protein induced by vitamin K absence or antagonist II-producing gastric cancer.
Protein induced by vitamin K absence or antagonist II-producing gastric cancer.
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DOI：
10.4291/wjgp.v1.i4.129
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发表时间：
2010-10-15
期刊：
影响因子：
--
通讯作者：
Fukusato, Toshio
中科院分区：
文献类型：
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作者：
Takahashi, Yoshihisa;Inoue, Tohru;Fukusato, Toshio
维生素 K 缺乏或拮抗剂 II 诱导的蛋白 (PIVKA-II) 是肝细胞癌 (HCC) 的推定特异性标志物，但少数胃癌也可能产生该蛋白。迄今为止，已报告 16 例产生 PIVKA-II 的胃癌，其中 2 例是我们报告的，全部在日本发现。产生PIVKA-II的胃癌没有特有的症状，典型的临床症状是全身疲劳、食欲不振和上腹痛。几乎所有病例的血清甲胎蛋白（AFP）水平也会升高。约80%的病例出现肝转移，约20%的病例出现门静脉癌栓。转移性肝肿瘤和 HCC 的鉴别诊断通常很困难。从总体上看，几乎所有病例都表现为晚期胃癌。在组织学上，除了中度至低分化的腺癌成分外，在许多病例中还观察到肝样模式。 PIVKA-II 和 AFP 的产生通常使用免疫组织化学染色来确认。治疗和预后很大程度上取决于是否存在肝转移，而肝转移患者的预后很差。 PIVKA-II可能在肿瘤细胞的肝细胞化生过程中产生。
Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a putative specific marker of hepatocellular carcinoma (HCC), but it may also be produced by a small number of gastric cancers. To date, 16 cases of PIVKA-II-producing gastric cancer have been reported, 2 of which were reported by us and all of which were identified in Japan. There are no symptoms specific to PIVKA-II-producing gastric cancer, and the representative clinical symptoms are general fatigue, appetite loss, and upper abdominal pain. Serum alpha-fetoprotein (AFP) levels are also increased in almost all cases. Liver metastasis is observed in approximately 80% of cases and portal vein tumor thrombus is observed in approximately 20% of cases. Differential diagnosis between metastatic liver tumor and HCC is often difficult. Grossly, almost all cases appear as advanced gastric cancer. Histologically, a hepatoid pattern is observed in many cases, in addition to a moderately to poorly differentiated adenocarcinoma component. The production of PIVKA-II and AFP is usually confirmed using immunohistochemical staining. Treatment and prognosis largely depends on the existence of liver metastasis, and the prognosis of patients with liver metastasis is very poor. PIVKA-II may be produced during the hepatocellularmetaplasia of the tumor cells.