Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma

doi:10.3748/wjg.v26.i29.4327

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Aug 7, 2020; 26(29): 4327-4342
Published online Aug 7, 2020. doi: 10.3748/wjg.v26.i29.4327

Table 1 Clinical and laboratory characteristics of the studied patients, n (%)

Variables	Sarcomatoid HCC, n = 41	High-grade HCC, n = 155	P value
Age at diagnosis, median (range), yr	54 (15-74)	55 (28-81)	0.942
Sex (male/female)	33/8	134/21	0.339
Follow-up duration, median (range), mo	10.5 (1.7-81.7)	27.7 (2.1-138.5)	< 0.001
Symptom at diagnosis	32 (78.0)	86 (55.5)	0.009
Alcoholism	10 (24.4)	38 (24.5)	0.987
HBsAg(+)	29 (70.7)	124 (80.0)	0.202
HCV-Ab(+)	3 (7.3)	5 (3.2)	0.368
Liver cirrhosis	32 (78.0)	133 (85.8)	0.226
Child-Pugh class, A/B	36/5	143/12	0.359
AFP, median (range), ng/mL	5.8 (1.0-16660.0)	348.0 (2.0-63208.5)	< 0.001
AFP level			< 0.001
≤ 20 ng/mL	26 (63.4)	33 (21.3)
> 20, < 400 ng/mL	10 (24.4)	47 (30.3)
≥ 400 ng/mL	5 (12.2)	75 (48.4)
Creatinine, median (range), mg/dL	0.77 (0.50-1.11)	0.76 (0.49-1.58)	0.475
ALT, median (range), U/L	26 (10-145)	32 (8-301)	0.204
Total bilirubin, median (range), mg/dL	0.85 (0.33-2.45)	0.95 (0.33-10.29)	0.095
Albumin, mean ± SD, g/dL	3.9 ± 0.5	4.0 ± 0.5	0.082
INR, median (range)	1.11 (0.96-1.53)	1.08 (0.84-1.50)	0.066

AFP: Alpha-fetoprotein; ALT: Alanine aminotransferase; HBsAg: Hepatitis B surface antigen; HCC: Hepatocellular carcinoma; HCV-Ab: Hepatitis C virus antibody; INR: International normalized ratio; SD: Standard deviation.

Table 2 Tumor-specific characteristics of the studied patients, n (%)

Variables	Sarcomatoid HCC, n = 41	High-grade HCC, n = 155	P value
Tumor size, median (range), cm	8.6 (1.5-24.0)	5.5 (1.3-19.0)	0.007
Tumor number, single/multiple	25/16	108/47	0.443
Tumor location			0.549
Left lobe	11 (26.8)	34 (21.9)
Right lobe	28 (68.3)	106 (68.4)
Both lobes	2 (4.9)	15 (9.7)
Tumor encapsulation	11 (26.8)	77 (49.7)	0.009
Tumor necrosis	35 (85.4)	53 (34.2)	< 0.001
Spontaneous rupture	4 (9.8)	9 (5.8)	0.477
Adjacent organ invasion	9 (22.0)	13 (8.4)	0.024
Satellite nodules	6 (14.6)	25 (16.1)	0.816
Macrovascular invasion	7 (17.1)	34 (21.9)	0.496
Microvascular invasion	16 (39.0)	63 (40.6)	0.851
Lymph node metastasis	9 (22.0)	9 (5.8)	0.004
Differentiation grade of the carcinomatous component			< 0.001
II	3 (7.3)	0 (0)
III	19 (46.4)	116 (74.8)
IV	8 (19.5)	39 (25.2)
NA¹	11 (26.8)	0 (0)
AJCC stage			0.006
Stage I	10 (24.4)	68 (43.9)
Stage II	7 (17.0)	25 (16.1)
Stage III	15 (36.6)	53 (34.2)
Stage IV	9 (22.0)	9 (5.8)
BCLC stage			0.543
0	0 (0)	2 (1.3)
A	19 (46.4)	95 (61.3)
B	6 (14.6)	15 (9.7)
C	16 (39.0)	43 (27.7)
Recurrence	34 (82.9)	108 (69.7)	0.091
Recurrence pattern	34	108	0.246
Intrahepatic	14 (41.2)	62 (57.4)
Extrahepatic	8 (23.5)	17 (15.7)
Both	12 (35.3)	29 (26.9)
Imaging data at diagnosis	36	139
Typical dynamic image patterns²	16 (44.4)	101 (72.7)	0.001

¹The tumor consists purely of sarcomatous components.

²Arterial phase enhancement, portal and delayed phase washout. AJCC: American Joint Committee on Cancer; BCLC: Barcelona Clinic Liver Cancer; HCC: Hepatocellular carcinoma; NA: Not available.

Table 3 Univariable and multivariable analyses of overall survival of the studied patients

Variables	HR (95%CI)	P value	HR (95%CI)	P value
Age, ≥ 55 yr vs < 55 yr	0.687 (0.477-0.991)	0.044	0.977 (0.654-1.460)	0.910
Sex, male vs female	0.972 (0.579-1.630)	0.913
Hepatitis virus infection, yes vs no	1.140 (0.718-1.811)	0.579
Alcoholism, yes vs no	1.101 (0.723-1.677)	0.653
Liver cirrhosis, yes vs no	1.027 (0.620-1.703)	0.917
Child-Pugh, B vs A	2.287 (1.281-4.083)	0.005	Excluded¹	Excluded
AFP, > 20 ng/mL vs ≤ 20 ng/mL	0.560 (0.386-0.813)	0.002	0.555 (0.377-0.817)	0.003
Tumor size, > 5 cm vs ≤ 5 cm	2.718 (1.806-4.089)	< 0.001	1.871 (1.146-3.054)	0.012
Tumor number, multiple vs single	1.647 (1.129-2.402)	0.010	Excluded	Excluded
Tumor encapsulation, yes vs no	0.443 (0.302-0.651)	< 0.001	Excluded	Excluded
Tumor necrosis, yes vs no	2.237 (1.548-3.233)	< 0.001	0.973 (0.622-1.523)	0.904
Macrovascular invasion, yes vs no	3.403 (2.256-5.133)	< 0.001	2.308 (1.438-3.702)	0.001
Microvascular invasion, yes vs no	1.615 (1.115-2.338)	0.011	Excluded	Excluded
Adjacent organ invasion, yes vs no	2.329 (1.407-3.857)	0.001	Excluded	Excluded
Lymph node metastasis, yes vs no	2.413 (1.371-4.249)	0.002	Excluded	Excluded
AJCC stage, III + IV vs I + II	3.221 (2.200-4.715)	< 0.001	1.763 (1.085-2.864)	0.022
Histological subtype, sHCC vs hgHCC	3.460 (2.283-5.243)	< 0.001	3.140 (2.032-4.851)	< 0.001
Differentiation grade of carcinomatous component		P_trend < 0.001		P_trend = 0.421
NA²	1 (reference)		1 (reference)
II	0.383 (0.083-1.758)	0.217	0.297 (0.062-1.422)	0.129
III	0.226 (0.115-0.444)	< 0.001	0.644 (0.281-1.475)	0.298
IV	0.327 (0.159-0.670)	0.002	0.739 (0.311-1.755)	0.494

¹Because of changing the matched hazard ratio of histological subtype less than 5%.

²The tumor consists purely of sarcomatous components. AFP: Alpha-fetoprotein; AJCC: American Joint Committee on Cancer; CI: Confidence interval; hgHCC: High-grade hepatocellular carcinoma; HR: Hazard ratio; NA: Not available; sHCC: Sarcomatoid hepatocellular carcinoma.

Table 4 Univariable and multivariable analyses of recurrence-free survival of the studied patients

Variables	HR (95% CI)	P value	HR (95% CI)	P value
Age, ≥ 55 yr vs < 55 yr	0.743 (0.533-1.035)	0.079	0.857 (0.605-1.214)	0.386
Sex, male vs female	0.771 (0.493-1.206)	0.254
Hepatitis virus infection, yes vs no	1.369 (0.879-2.133)	0.165
Alcoholism, yes vs no	0.940 (0.634-1.394)	0.759
Liver cirrhosis, yes vs no	1.283 (0.790-2.084)	0.314
Child-Pugh, B vs A	1.699 (0.938-3.078)	0.081	Excluded¹	Excluded
AFP, > 20 ng/mL vs ≤ 20 ng/mL	0.710 (0.501-1.006)	0.054	0.680 (0.469-0.986)	0.042
Tumor size, > 5 cm vs ≤ 5 cm	2.398 (1.685-3.413)	< 0.001	1.680 (0.469-0.986)	0.015
Tumor number, multiple vs single	2.058 (1.460-2.902)	< 0.001	1.210 (0.824-1.777)	0.331
Tumor encapsulation, yes vs no	0.561 (0.400-0.786)	0.001	Excluded	Excluded
Tumor necrosis, yes vs no	1.726 (1.239-2.404)	0.001	Excluded	Excluded
Macrovascular invasion, yes vs no	2.922 (1.961-4.354)	< 0.001	Excluded	Excluded
Microvascular invasion, yes vs no	1.646 (1.178-2.300)	0.003	Excluded	Excluded
Adjacent organ invasion, yes vs no	2.329 (1.445-3.753)	0.001	Excluded	Excluded
Lymph node metastasis, yes vs no	2.327 (1.356-3.992)	0.002	Excluded	Excluded
AJCC stage, III + IV vs I + II	3.416 (2.420-4.821)	< 0.001	2.752 (1.879-4.032)	< 0.001
Histological subtype, sHCC vs hgHCC	2.842 (1.913-4.222)	< 0.001	2.355 (1.564-3.546)	< 0.001
Differentiation grade of carcinomatous component		P_trend = 0.036		P_trend = 0.194
NA²	1 (reference)		1 (reference)
II	1.001 (0.264-3.790)	0.999	0.650 (0.162-2.603)	0.543
III	0.445 (0.215-0.922)	0.029	1.605 (0.672-3.832)	0.287
IV	0.642 (0.298-1.380)	0.256	2.025 (0.822-4.988)	0.125

¹Because of changing the matched hazard ratio of histological subtype less than 5%.

²The tumor consists purely of sarcomatous components. AFP: Alpha-fetoprotein; AJCC: American Joint Committee on Cancer; CI: Confidence interval; hgHCC: High-grade hepatocellular carcinoma; HR: hazard ratio; NA: Not available; sHCC: Sarcomatoid hepatocellular carcinoma.

Citation: Wang JP, Yao ZG, Sun YW, Liu XH, Sun FK, Lin CH, Ren FX, Lv BB, Zhang SJ, Wang Y, Meng FY, Zheng SZ, Gong W, Liu J. Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma. World J Gastroenterol 2020; 26(29): 4327-4342
URL: https://www.wjgnet.com/1007-9327/full/v26/i29/4327.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i29.4327