Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population-based analysis.
histological subtype
sarcomatoid hepatocellular carcinoma
survival
survival predictor
tumor grade
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
01 Nov 2019
01 Nov 2019
Historique:
received:
03
05
2019
revised:
04
06
2019
accepted:
19
06
2019
pubmed:
13
7
2019
medline:
27
5
2020
entrez:
13
7
2019
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
Few data are available regarding the management and outcomes among patients with sarcomatoid hepatocellular carcinoma (HCC) due to its rarity.
METHODS
METHODS
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.
RESULTS
RESULTS
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).
CONCLUSIONS
CONCLUSIONS
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3767-3775Informations de copyright
© 2019 American Cancer Society.
Références
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87-108.
Njei B, Rotman Y, Ditah I, Lim JK. Emerging trends in hepatocellular carcinoma incidence and mortality. Hepatology. 2015;61:191-199.
Liao SH, Su TH, Jeng YM, et al. Clinical manifestations and outcomes of patients with sarcomatoid hepatocellular carcinoma. Hepatology. 2019;69:209-221.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182-236.
Calderaro J, Couchy G, Imbeaud S, et al. Histological subtypes of hepatocellular carcinoma are related to gene mutations and molecular tumour classification. J Hepatol. 2017;67:727-738.
Moris D, Pawlik TM. Personalized treatment in patients with colorectal liver metastases. J Surg Res. 2017;216:26-29.
Shafizadeh N, Kakar S. Hepatocellular carcinoma: histologic subtypes. Surg Pathol Clin. 2013;6:367-384.
Torbenson MS. Morphologic subtypes of hepatocellular carcinoma. Gastroenterol Clin North Am. 2017;46:365-391.
Li J, Liang P, Zhang D, et al. Primary carcinosarcoma of the liver: imaging features and clinical findings in six cases and a review of the literature. Cancer Imaging. 2018;18:7.
Shi D, Ma L, Zhao D, et al. Imaging and clinical features of primary hepatic sarcomatous carcinoma. Cancer Imaging. 2018;18:36.
Gu KW, Kim YK, Min JH, Ha SY, Jeong WK. Imaging features of hepatic sarcomatous carcinoma on computed tomography and gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol (NY). 2017;42:1424-1433.
Koo HR, Park MS, Kim MJ, et al. Radiological and clinical features of sarcomatoid hepatocellular carcinoma in 11 cases. J Comput Assist Tomogr. 2008;32:745-749.
Jernigan PL, Wima K, Hanseman DJ, et al. Natural history and treatment trends in hepatocellular carcinoma subtypes: insights from a national cancer registry. J Surg Oncol. 2015;112:872-876.
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A, eds. AJCC Cancer Staging Manual. 7th ed. New York: Springer; 2010.
Boffa DJ, Rosen JE, Mallin K, et al. Using the National Cancer Database for outcomes research: a review. JAMA Oncol. 2017;3:1722-1728.
Gani F, Goel U, Blair AB, et al. Minimally invasive versus open primary resection for retroperitoneal soft tissue sarcoma: a propensity-matched study from the National Cancer Database. Ann Surg Oncol. 2018;25:2209-2217.
Klabunde CN, Potosky AL, Legler JM, Warren JL. Development of a comorbidity index using physician claims data. J Clin Epidemiol. 2000;53:1258-1267.
American College of Surgeons. National Cancer Database: Patient User File Data Dictionary Items. https://www.facs.org/quality-programs/cancer/ncdb/puf. Accessed December 1, 2016.
United States Department of Agriculture Economic Research Service. Rural-urban continuum codes. http://www.ers.usda.gov/data-products/rural-urban-continuum-codes.aspx. Accessed April 15, 2019.
American College of Surgeons Commission on Cancer. About cancer program categories. https://www.facs.org/quality-programs/cancer/accredited/about/categories. Accessed April 15, 2019.
Giunchi F, Vasuri F, Baldin P, Rosini F, Corti B, D’Errico-Grigioni A. Primary liver sarcomatous carcinoma: report of two cases and review of the literature. Pathol Res Pract. 2013;209:249-254.
Lee KB. Sarcomatoid hepatocellular carcinoma with mixed osteoclast-like giant cells and chondroid differentiation. Clin Mol Hepatol. 2014;20:313-316.
Yu Y, Zhong Y, Wang J, Wu D. Sarcomatoid hepatocellular carcinoma (SHC): a case report. World J Surg Oncol. 2017;15:219.
Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018;67:358-380.