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Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma

BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the fourth leading cause of cancer-related death worldwide. Sarcomatoid HCC, which contains poorly differentiated carcinomatous and sarcomatous components, is a rare histological subtype of HCC that differs from c...

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Autores principales: Wang, Jian-Ping, Yao, Zhi-Gang, Sun, Ya-Wen, Liu, Xi-Han, Sun, Feng-Kai, Lin, Cun-Hu, Ren, Fu-Xin, Lv, Bei-Bei, Zhang, Shuai-Jun, Wang, Yang, Meng, Fan-Ying, Zheng, Shun-Zhen, Gong, Wei, Liu, Jun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422543/
https://www.ncbi.nlm.nih.gov/pubmed/32848337
http://dx.doi.org/10.3748/wjg.v26.i29.4327
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author Wang, Jian-Ping
Yao, Zhi-Gang
Sun, Ya-Wen
Liu, Xi-Han
Sun, Feng-Kai
Lin, Cun-Hu
Ren, Fu-Xin
Lv, Bei-Bei
Zhang, Shuai-Jun
Wang, Yang
Meng, Fan-Ying
Zheng, Shun-Zhen
Gong, Wei
Liu, Jun
author_facet Wang, Jian-Ping
Yao, Zhi-Gang
Sun, Ya-Wen
Liu, Xi-Han
Sun, Feng-Kai
Lin, Cun-Hu
Ren, Fu-Xin
Lv, Bei-Bei
Zhang, Shuai-Jun
Wang, Yang
Meng, Fan-Ying
Zheng, Shun-Zhen
Gong, Wei
Liu, Jun
author_sort Wang, Jian-Ping
collection PubMed
description BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the fourth leading cause of cancer-related death worldwide. Sarcomatoid HCC, which contains poorly differentiated carcinomatous and sarcomatous components, is a rare histological subtype of HCC that differs from conventional HCC. It is highly aggressive and has a poor prognosis. Its clinicopathological characteristics, surgical outcomes and underlying mechanisms of its highly aggressive nature have not been fully elucidated. AIM: To examine the clinicopathological characteristics and surgical outcomes of sarcomatoid HCC and explore the histogenesis of sarcomatoid HCC. METHODS: In total, 196 patients [41 sarcomatoid HCC and 155 high-grade (Edmondson-Steiner grade III or IV) HCC] who underwent surgical resection between 2007 and 2017 were retrospectively reviewed. The characteristics and surgical outcomes of sarcomatoid HCC were compared with those of patients with high-grade HCC. The histological composition of invasive and metastatic sarcomatoid HCCs was evaluated. RESULTS: Sarcomatoid HCC was more frequently diagnosed at an advanced stage with a larger tumor and higher rates of nonspecific symptom, adjacent organ invasion and lymph node metastasis than high-grade HCC (all P < 0.05). Compared with high-grade HCC patients, sarcomatoid HCC patients are less likely to have typical dynamic imaging features of HCC (44.4% vs 72.7%, P = 0.001) and elevated serum alpha-fetoprotein levels (> 20 ng/mL; 36.6% vs 78.7%, P < 0.001). The sarcomatoid group had a significantly shorter median recurrence-free survival (5.6 mo vs 16.4 mo, log-rank P < 0.0001) and overall survival (10.5 mo vs 48.1 mo, log-rank P < 0.0001) than the high-grade group. After controlling for confounding factors, the sarcomatoid subtype was identified as an independent predictor of poor prognosis. Pathological analyses indicated that invasive and metastatic lesions were mainly composed of carcinomatous components. CONCLUSION: Sarcomatoid HCC was associated with a more advanced stage, atypical dynamic imaging, lower serum alpha-fetoprotein levels and a worse prognosis. The highly aggressive nature of sarcomatoid HCC is perhaps mediated by carcinomatous components.
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spelling pubmed-74225432020-08-25 Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma Wang, Jian-Ping Yao, Zhi-Gang Sun, Ya-Wen Liu, Xi-Han Sun, Feng-Kai Lin, Cun-Hu Ren, Fu-Xin Lv, Bei-Bei Zhang, Shuai-Jun Wang, Yang Meng, Fan-Ying Zheng, Shun-Zhen Gong, Wei Liu, Jun World J Gastroenterol Retrospective Study BACKGROUND: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer and the fourth leading cause of cancer-related death worldwide. Sarcomatoid HCC, which contains poorly differentiated carcinomatous and sarcomatous components, is a rare histological subtype of HCC that differs from conventional HCC. It is highly aggressive and has a poor prognosis. Its clinicopathological characteristics, surgical outcomes and underlying mechanisms of its highly aggressive nature have not been fully elucidated. AIM: To examine the clinicopathological characteristics and surgical outcomes of sarcomatoid HCC and explore the histogenesis of sarcomatoid HCC. METHODS: In total, 196 patients [41 sarcomatoid HCC and 155 high-grade (Edmondson-Steiner grade III or IV) HCC] who underwent surgical resection between 2007 and 2017 were retrospectively reviewed. The characteristics and surgical outcomes of sarcomatoid HCC were compared with those of patients with high-grade HCC. The histological composition of invasive and metastatic sarcomatoid HCCs was evaluated. RESULTS: Sarcomatoid HCC was more frequently diagnosed at an advanced stage with a larger tumor and higher rates of nonspecific symptom, adjacent organ invasion and lymph node metastasis than high-grade HCC (all P < 0.05). Compared with high-grade HCC patients, sarcomatoid HCC patients are less likely to have typical dynamic imaging features of HCC (44.4% vs 72.7%, P = 0.001) and elevated serum alpha-fetoprotein levels (> 20 ng/mL; 36.6% vs 78.7%, P < 0.001). The sarcomatoid group had a significantly shorter median recurrence-free survival (5.6 mo vs 16.4 mo, log-rank P < 0.0001) and overall survival (10.5 mo vs 48.1 mo, log-rank P < 0.0001) than the high-grade group. After controlling for confounding factors, the sarcomatoid subtype was identified as an independent predictor of poor prognosis. Pathological analyses indicated that invasive and metastatic lesions were mainly composed of carcinomatous components. CONCLUSION: Sarcomatoid HCC was associated with a more advanced stage, atypical dynamic imaging, lower serum alpha-fetoprotein levels and a worse prognosis. The highly aggressive nature of sarcomatoid HCC is perhaps mediated by carcinomatous components. Baishideng Publishing Group Inc 2020-08-07 2020-08-07 /pmc/articles/PMC7422543/ /pubmed/32848337 http://dx.doi.org/10.3748/wjg.v26.i29.4327 Text en ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. http://creativecommons.org/licenses/by-nc/4.0/ This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
spellingShingle Retrospective Study
Wang, Jian-Ping
Yao, Zhi-Gang
Sun, Ya-Wen
Liu, Xi-Han
Sun, Feng-Kai
Lin, Cun-Hu
Ren, Fu-Xin
Lv, Bei-Bei
Zhang, Shuai-Jun
Wang, Yang
Meng, Fan-Ying
Zheng, Shun-Zhen
Gong, Wei
Liu, Jun
Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title_full Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title_fullStr Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title_full_unstemmed Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title_short Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
title_sort clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma
topic Retrospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422543/
https://www.ncbi.nlm.nih.gov/pubmed/32848337
http://dx.doi.org/10.3748/wjg.v26.i29.4327
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