Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan.
Hepatol Int. 2021 Apr;15(2):472-481. doi: 10.1007/s12072-021-10146-1. Epub 2021 Feb 5.
The scirrhous hepatocellular carcinoma (HCC) is a rare subtype characterized by prominent fibrous stroma separating nests of tumor cells histologically. The clinical characteristics of scirrhous HCC have not been clearly elucidated due to limited literatures. We aimed to investigate the clinical manifestations and outcomes of patients with scirrhous HCC.
A total of 4012 patients with histologically proven HCC from the Cancer Registry Database (2004-2016) of the National Taiwan University Hospital (NTUH) were enrolled; whereas, 30 patients with scirrhous HCC were identified from the pathology database of NTUH. We matched 120 patients with non-scirrhous HCC through propensity score according to sex, age, Barcelona Clinic Liver Cancer stage and initial treatment modality for comparison.
No significant difference in baseline characteristics and presentations was observed between the patients with scirrhous and non-scirrhous HCC except baseline alpha-fetoprotein level. The overall survival was comparable in these two groups. For the patients undergoing curative therapy, the risk of recurrence in the patients with scirrhous HCC was significantly higher within 24 months after curative therapy (hazard ratio [HR], 2.88, 95% confidence interval [CI], 1.43-5.80, p value, 0.003) as compared with those with non-scirrhous HCC. The overall recurrence rate was comparable in these two groups.
Using propensity score matching, the risk of recurrence in the patients with scirrhous HCC was significantly higher in the first 2 years after curative therapy as compared to those with non-scirrhous HCC. An individualized post-curative treatment monitoring strategy should be considered for the patients with scirrhous HCC.
硬癌型肝细胞癌（HCC）是一种罕见的亚型，其特征是组织学上肿瘤细胞巢被显著的纤维基质分隔。由于文献有限，硬癌型 HCC 的临床特征尚未得到明确阐明。我们旨在研究硬癌型 HCC 患者的临床表现和结局。
共纳入了来自国立台湾大学医院（NTUH）癌症登记数据库（2004-2016 年）的 4012 例经组织学证实的 HCC 患者，其中 30 例来自 NTUH 的病理数据库。我们根据性别、年龄、巴塞罗那临床肝癌分期和初始治疗方式，通过倾向评分匹配了 120 例非硬癌型 HCC 患者进行比较。
除了基线甲胎蛋白水平外，硬癌型和非硬癌型 HCC 患者在基线特征和表现方面无显著差异。两组患者的总生存率相当。对于接受根治性治疗的患者，硬癌型 HCC 患者在根治性治疗后 24 个月内复发的风险显著高于非硬癌型 HCC 患者（风险比 [HR]，2.88，95%置信区间 [CI]，1.43-5.80，p 值，0.003）。两组患者的总复发率相当。
使用倾向评分匹配，与非硬癌型 HCC 患者相比，硬癌型 HCC 患者在根治性治疗后 2 年内复发的风险显著更高。对于硬癌型 HCC 患者，应考虑制定个体化的根治后治疗监测策略。
