Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma
Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma
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DOI：
10.1002/hep.30162
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发表时间：
2019-01-01
期刊：
影响因子：
13.5
通讯作者：
Kao, Jia-Horng
中科院分区：
文献类型：
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作者：
Liao, Sih-Han;Su, Tung-Hung;Kao, Jia-Horng
肝细胞癌（HCC）是全球第五大常见癌症，也是导致癌症相关死亡的第二大原因。肉瘤样HCC是一种罕见的组织学亚型，临床表现和预后大多不明确。我们评估了肉瘤样HCC患者的临床表现和预后。我们从国立台湾大学医院癌症登记数据库（1996-2016）中确定了5047例组织学证实的HCC患者。其中40例肉瘤样HCC患者来自台大医院病理数据库。我们纳入了160例非肉瘤样HCC患者，根据性别、年龄和巴塞罗那临床肝癌分期进行倾向评分匹配。这些肉瘤样HCC患者中大多数为男性（75%）；他们的平均年龄为58岁。只有47.5%的肉瘤样HCC患者表现出典型的HCC影像学特征。与非肉瘤样HCC相比，肉瘤样HCC的病理分级更先进（III级和IV级分别为42.5%和23.8%,P < 0.0001）。与非肉瘤样组相比，肉瘤样组的中位无复发生存期（13.3个月vs 84.2个月，log-rank P < 0.0001）和总生存期（8.3个月vs 69.3个月，log-rank P < 0.0001）显著缩短。多变量Cox比例风险模型结果显示，组织学肉瘤样亚型是全因死亡率（风险比[HR]， 6.47； 95%可信区间[CI]， 3.12-13.43; P < 0.0001）和肿瘤复发（风险比，4.08;95% CI, 1.72-9.66; P = 0.001）的独立因素。结论：与非肉瘤样肝细胞癌相比，肉瘤样肝细胞癌具有更高的组织学分级和非典型影像学特征。组织学肉瘤样亚型是肝癌患者治愈治疗后肿瘤复发和全因死亡率的独立预测因子。
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths worldwide. Sarcomatoid HCC is a rare histological subtype of HCC with largely unclear clinical manifestations and outcomes. We evaluated the clinical manifestations and outcomes of patients with sarcomatoid HCC. We identified 5,047 patients with histologically proven HCC from the Cancer Registry Database (1996-2016) of National Taiwan University Hospital. Among them, 40 patients with sarcomatoid HCC were identified from the pathology database of National Taiwan University Hospital. We included 160 patients with nonsarcomatoid HCC through propensity score matching according to sex, age, and Barcelona Clinic Liver Cancer stage. The majority of these patients with sarcomatoid HCC were men (75%); their median age was 58 years. Only 47.5% of the patients with sarcomatoid HCC presented with typical image patterns of HCC. The pathological grading of sarcomatoid HCC was more advanced compared with that of nonsarcomatoid HCC (42.5% vs. 23.8% in grade III and IV, P < 0.0001). The sarcomatoid group had significantly shorter median recurrence-free (13.3 vs. 84.2 months, log-rank P < 0.0001) and overall (8.3 vs. 69.3 months, log-rank P < 0.0001) survival than did the nonsarcomatoid group. The results of the multivariable Cox proportional hazard model revealed histological sarcomatoid subtype as an independent factor for all-cause mortality (hazard ratio [HR], 6.47; 95% confidence interval [CI], 3.12-13.43; P < 0.0001) and tumor recurrence (HR, 4.08; 95% CI, 1.72-9.66; P = 0.001). Conclusion: Compared with nonsarcomatoid HCC, sarcomatoid HCC was associated with more advanced histological grades and atypical image patterns. Histological sarcomatoid subtype is an independent predictor of tumor recurrence after curative treatment and all-cause mortality in patients with HCC.