Tumer marker gastrointestinal cancer Introdution Gastro- Intestinal m a r k e r 1
10 2
(glandular epithlium cells) (squamous cell) (stricture) metaplasia () (N.R. Barrett) a 1/5 b12 3
( 90%) ( ) I. II. IIa IIb IIIc III. 4
I. II. III. IV. PS: Krukenberg's tumor ) (Linitis Plastica ) 1. 2. 2 1 (30 50 ) 0.8 1 1 1 3. 90% 4. 5
(Linitis Plastica ) E-cadherin 酶 (Linitis Plastica ) 6
(Linitis Plastica ) 酶.. 7
x GroES (Urea Breath Test) Tumor Mark??? 8
90% 50%15% 90% 30% 9
Gardner s (Crohn's ) ras c-myc DCC p53 5q21 MCC FAP 10
FCC APC Hypomehtylation Miscellaneous ( K- ras) DCC p53 nm23 () (95%) 45% 25%5% 16% 9% Carcinoid tumors Gastrointestinal stromal tumors Lymphomas: cancers ) 11
70-80% (GIST) 0.1~3% (non-epithelial neoplasms) (leiomyoma) (leiomyosarcoma) KIT gain of function mutation(point mutaion) 12
(GIST) (GIST) KIT CD117 KIT 13
(GIST) Heinrich(Scienc e 2003) KIT PDGFRA (ramification) KIT PDGFRA (GIST) KIT ( "") (noncomplex or even normal karyotype)14 (deletion) 14 (loss)1p 9p 11p22q 8q 17q (amplification) El-Rifai(Cancer Res 2000) 14
(GIST) 90% a) (R0 resection) b) (extensive lymph node sampling) (GIST) (MDR gene) Glivec(imatinib mesylate) ( ) 15
Glivec(imatinib mesylate) 1. Glivec(imatinib mesylate, STI-571)Novartis Pharmaceuticals 酶 (tyrosine kinase)abl ABL-2(ABL-related gene) Kit PDGF-R() chimeric BCR-ABL Imatinib mesylate 酶 (tyrosine kinase) 酶 ATP (substrate) imatinib mesylate KIT 酶 2. GlivecBCR-ABL c-kit PDGF-R (multitargeting agent) Glivec(imatinib mesylate) Heinrich(JCO 2003) 127 KIT PDGFRA112KIT (88.2%) 6PDGFRA(4.7%) 9 (7.1%)KIT PDGFRA KITexon 9 exon 11 85 exon 11 83.5% 23 exon 9 47.8% (P =.0006) KIT PDGFRA 0% (P <.0001) PDGFRA PDGFRA KIT imatinib mesylatekit PDGFRA 16
X X Tumor marker??? 17
Tumor marker CA72-4 CA19-9 CEA 18
Tumor marker CA72-4 CA19-9 CEA 44 2.3% 11.4% 56 37.5% 17.9% 50% 16.3% 161 42.2% 32.3% 9.1% 35.7% 8.3% 24.2% Stage A Stage B Stage C Stage D 31 59 60 50 200 CA 72-4 > 6 u/ml 3.2% 30.55% 53.3% 70% 43% 9% 22% 41.7% 78% 43% CEA > 5ng/ml Tumor marker 19
CA72-4 CA72-4 TAG-72 (tumor associated antigen) CA72-4 CA19-9 CA19-9 (70%~100%) (22~51%) (42%) (20%) CA19-910000U/ml 20
CEA 1965 Gold Freedman 180-kd 30 CEA 40-70% CEA 21
Fas Circulating Soluble Fas Ligand in Patients with Gastric Carcinoma Cancer, Vol89, No12(December 15), 2000:pp2560-2564 Tsutsumi S, Kuwano H, Shimura T, Morinaga N, Mochiki E, and Asao T Fas Fas(Fas ligand, FasL) FasL T Fas, T;, FasL, FasL(soluble Fas ligand, sfasl), FasL, 22
43sFasL 0.1ng/mL 166sFasL 0.04 ng/ml, (P = 0.738) sfasl, sfasl ( 0,, ) (P<0.001), sfasl,, sfasl(0.08 ng/ml), sfaslsfasl, sfasl(p<0.001) sfasl(p = 0.041) The end & thank your attention & Happy new year 23
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