Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio.
Cancer. 2019 Nov 1;125(21):3767-3775. doi: 10.1002/cncr.32396. Epub 2019 Jul 12.
Few data are available regarding the management and outcomes among patients with sarcomatoid hepatocellular carcinoma (HCC) due to its rarity.
Patients diagnosed with sarcomatoid HCC from 2004 through 2015 were identified in the National Cancer Data Base. Overall survival (OS) was calculated among patients with sarcomatoid versus conventional HCC using a 1:3 propensity score matching based on sex, age, and American Joint Committee on Cancer (AJCC) stage of disease.
The final analytic cohort included 104 patients with sarcomatoid HCC and 312 patients with conventional HCC. Patients with sarcomatoid HCC more often had a larger median tumor size (8.5 cm vs 5.4 cm; P < .001) and poorly or undifferentiated tumors (52.9% vs 13.8%; P < .001) compared with patients who had conventional HCC. 5-year OS was worse among patients with sarcomatoid versus conventional HCC (5.7% vs 30.1%; P < .001). Subgroup analysis demonstrated worse 5-year OS among patients with sarcomatoid versus conventional HCC among patients treated with either curative-intent or palliative therapies. Stage-specific subgroup analysis indicated a worse OS among patients with AJCC stage I, stage II, or stage III sarcomatoid HCC. On multivariable analysis, uninsured status, advanced AJCC stage (stage III/stage IV), and histological sarcomatoid subtype were independently associated with worse outcomes (all P < .05).
Sarcomatoid HCC is a very rare variant of HCC, which was associated with larger tumor size and worse tumor grade on presentation. On propensity score matched analyses that controlled for known confounding factors, patients with sarcomatoid HCC had a worse stage-for-stage long-term survival compared with patients who had conventional HCC.
由于肉瘤样肝细胞癌（HCC）罕见，因此关于其治疗和预后的数据很少。
在国家癌症数据库中，确定了 2004 年至 2015 年期间诊断为肉瘤样 HCC 的患者。使用基于性别、年龄和美国癌症联合委员会（AJCC）疾病分期的 1:3 倾向评分匹配，比较肉瘤样 HCC 患者与常规 HCC 患者的总生存率（OS）。
最终分析队列包括 104 例肉瘤样 HCC 患者和 312 例常规 HCC 患者。与常规 HCC 患者相比，肉瘤样 HCC 患者的中位肿瘤大小更大（8.5cm 与 5.4cm；P<0.001），肿瘤分化程度更差或未分化（52.9%与 13.8%；P<0.001）。肉瘤样 HCC 患者的 5 年 OS 明显差于常规 HCC 患者（5.7%与 30.1%；P<0.001）。亚组分析表明，接受根治性或姑息性治疗的肉瘤样 HCC 患者的 5 年 OS 更差。根据 AJCC 分期的亚组分析表明，I 期、II 期或 III 期肉瘤样 HCC 患者的 OS 更差。多变量分析表明，无保险状态、晚期 AJCC 分期（III 期/IV 期）和组织学肉瘤样亚型与预后不良独立相关（均 P<0.05）。
肉瘤样 HCC 是 HCC 的一种罕见变异，其表现为肿瘤较大且肿瘤分级较差。在控制了已知混杂因素的倾向评分匹配分析中，肉瘤样 HCC 患者的长期生存情况与常规 HCC 患者相比每一期都更差。
