Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
J Gastrointest Surg. 2020 May;24(5):1049-1060. doi: 10.1007/s11605-019-04282-1. Epub 2019 Jun 26.
Scirrhous hepatocellular carcinoma (HCC) is a rare primary liver tumor characterized by extensive fibrosis and production of parathyroid hormone-related peptide. There have been conflicting reports on patient survival in scirrhous versus non-scirrhous HCC. The objective of the present study was to define the clinical features, practice patterns, and long-term outcomes of patients with scirrhous HCC versus non-scirrhous HCC in a propensity score-matched cohort.
A propensity score-matched cohort was created using data from the National Cancer Database for 2004 to 2015. A multivariable Cox proportional hazards regression analysis was performed to assess the effect of the scirrhous HCC variant on overall survival.
Among the 70,426 patients with a diagnosis of HCC who met the inclusion criteria, 99.8% had non-scirrhous HCC (n = 70,290) whereas a small subset had scirrhous HCC (n = 136, 0.19%). While 20,330 (28.9%) patients underwent liver-directed therapy (resection, ablation, and transplantation), the majority did not (n = 50,096, 71.1%). After propensity matching, there were no difference in 1-, 3-, or 5-year overall survival among patients with scirrhous versus non-scirrhous HCC (1-year overall survival (OS), 53.7% versus 51.0%; 3-year OS, 34.6% versus 28.7%; and 5-year OS, 18.0% versus 21.0%, respectively; p = 0.52). While the scirrhous HCC variant was not associated with survival (hazard ratio [HR] 0.93, 95% CI 0.74-1.16), non-receipt of liver-directed therapy (HR 0.24, 95% CI 0.18-0.32), advanced AJCC stage (III/IV) (HR 2.14, 95% CI 1.55-2.95), and non-academic facilities (HR 0.60, 95% CI 0.49-0.73) remained associated with worse survival.
Patients with the scirrhous variant had a comparable overall survival compared with individuals who had non-scirrhous HCC. Failure to receive liver-directed therapy, advanced AJCC stage (III/IV), and treatment at a non-academic facility was strongly associated with a worse long-term prognosis.
硬癌型肝细胞癌（HCC）是一种罕见的原发性肝癌，其特征为广泛纤维化和甲状旁腺激素相关肽的产生。硬癌型 HCC 与非硬癌型 HCC 患者的生存情况存在相互矛盾的报告。本研究的目的是在倾向评分匹配队列中确定硬癌型 HCC 与非硬癌型 HCC 患者的临床特征、治疗模式和长期结局。
使用 2004 年至 2015 年国家癌症数据库的数据创建了倾向评分匹配队列。采用多变量 Cox 比例风险回归分析评估硬癌型 HCC 变异对总生存的影响。
在符合纳入标准的诊断为 HCC 的 70426 例患者中，99.8%（n=70290）为非硬癌型 HCC，而一小部分为硬癌型 HCC（n=136，0.19%）。虽然有 20330 例（28.9%）患者接受了肝定向治疗（切除术、消融术和移植术），但大多数患者未接受治疗（n=50096，71.1%）。在倾向评分匹配后，硬癌型 HCC 与非硬癌型 HCC 患者的 1 年、3 年和 5 年总生存率无差异（1 年总生存率（OS），53.7%比 51.0%；3 年 OS，34.6%比 28.7%；5 年 OS，18.0%比 21.0%；p=0.52）。硬癌型 HCC 变异与生存无关（风险比[HR]0.93，95%CI0.74-1.16），但未接受肝定向治疗（HR0.24，95%CI0.18-0.32）、AJCC 晚期分期（III/IV 期）（HR2.14，95%CI1.55-2.95）和非学术机构（HR0.60，95%CI0.49-0.73）仍与生存率较差相关。
硬癌型 HCC 患者的总体生存率与非硬癌型 HCC 患者相当。未接受肝定向治疗、AJCC 晚期分期（III/IV 期）和非学术机构治疗与较差的长期预后密切相关。
