An evaluation of serum biochemical indexes, pathological characteristics and surgical treatment efficacy of sarcomatoid hepatocellular carcinoma

Abstract

Abstract: Objective To review the clinicopathological data and surgical treatment efficacy of sarcomatoid and high-grade hepatocellular carcinoma (HCC) cases, so as to provide clinical information for sarcomatoid HCC. Methods The data of sarcomatoid and high-grade HCC patients who underwent surgery from January 2007 to March 2018 were reviewed. Edmondson-Steiner pathological grade III ~ IV cases were defined as high-grade HCC. A total of 21 cases of sarcomatoid HCC and 74 cases of high-grade HCC patients with followed-up data were included in the final analysis. Clinicopathological data, and survival conditions of sarcomatoid and high-grade HCC patients were compared. Results There were significant differences in sex, HBsAg(+) and AFP between sarcoma-like and high-grade HCC patients (P<0.05), but there were no significant differences in age, HCV-Ab, liver cirrhosis, ALT, TBil, Alb and INR (P>0.05). The tumor diameters of sarcomatoid and high-grade HCC patients were 8.3 (1.6, 24.5) cm and 5.4 (1.3, 17.0) cm, the difference was statistically significant (P<0.05). Sarcoma-like HCC had tumor envelope, tumor necrosis, adjacent organ invasion and lymph node metastasis in 5 cases (23.8%), 17 cases (80.9%), 5 cases (23.8%) and 6 cases (28.6%), which were compared with high-grade HCC [37 cases (50.0%), 26 cases (35.1%), 6 cases (8.1%) and 4 cases (5.4%), respectively, the difference was statistically significant (P<0.05). The median OS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients [10.4 months vs 48.0 months, P<0.05]. The 1-year, 3-year and 5-year OS rates of sarcomatoid HCC were 52.4% (11/21), 19.0% (4/21) and 14.3% (3/21), while those of high-grade HCC were 85.1% (63/74), 54.0% (40/74) and 40.5% (30/74), respectively, the difference was statistically significant (P<0.05). The median RFS of sarcomatoid HCC patients was shorter than that of high-grade HCC patients [5.5 months vs 16.5 months, P<0.05]. The half-year, one-year and three-year RFS rates of sarcomatoid HCC were 47.6% (10/21), 23.8% (5/21) and 9.5% (2/21), respectively, which were significantly lower than those of high-grade HCC [82.4% (61/74), 59.4% (44/74) and 33.8% (25/74), respectively], the difference was statistically significant (P<0.05). Conclusion Compared with high-grade HCC, sarcomatoid HCC has a lower AFP level, more frequent tumor invasion and lymph node metastasis, and a poorer prognosis. The high invasiveness of sarcomatoid HCC may be mediated by specific cancerous components.

Key words: Sarcomatoid hepatocellular carcinoma, Alpha-fetoprotein, Overall survival

MA Bo-heng, WANG Xia, WU Ying. An evaluation of serum biochemical indexes, pathological characteristics and surgical treatment efficacy of sarcomatoid hepatocellular carcinoma[J]. Chinese Hepatolgy, 2023, 28(6): 676-679.

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