Clinicopathological characteristics and surgical outcomes of sarcomatoid hepatocellular carcinoma

Abstract

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.

Primary Liver Sarcomatoid Carcinoma: A Case Series and Literature Review

“…In diffusion weighted imaging (DWI) mapping, multiple cystic changes accompanied by fibrous septum exhibit nonhomogeneous and hyperintense changes in the center, which is also similar to an atypical liver abscess. 15 Drainage in misdiagnosed cases has occurred in clinical practice as previous reports by Wang et al 36 and Shi et al, 37 including two cases in this study (Cases 11 and 12). After investigating 6901 cases of malignant liver tumors, Seo et al 38 reported that PLSC patients had a greater prevalence of rim enhancements than PLC patients.…”

“…[11][12][13][14] A significantly higher incidence of SHC with hepatitis has been reported, which is similar to the epidemiological characteristics of HCC, indicating the tumorigenesis of SHC. 15,16 Another notable observation has been that PLSC is prevalent in Asian countries, especially in China, the Republic of Korea, and Japan, 17 but there are less cases infected with hepatitis in Japan. A 29-year-old PLSC patient has been reported with a 10-year history of schistosomiasis, who was negative for hepatitis B and C. 9 Besides PLSC, schistosomiasis infection was also reported in bladder sarcomatoid carcinoma.…”

All-trans retinoic acid inhibits the malignant behaviors of hepatocarcinoma cells by regulating ferroptosis

“…The prognosis of HCC still remains poor, and is inextricably linked to its high recurrence and frequent metastases. 4 , 5 Therefore, recent studies on HCC have mainly focused on how to effectively control its rapid growth and prevent its metastasis. 6 , 7 …”

CtBP1 Mediates Hypoxia-Induced Sarcomatoid Transformation in Hepatocellular Carcinoma

“…1 The incidence of sHCC ranges from 1.8% to 3.9% of all HCC cases. 2,3 sHCC can be the primary tumor but is mainly secondary tumors in patients undergoing repeated chemotherapy, transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and percutaneous ethanol injection. 1 sHCC shows a more aggressive phenotype with a higher TNM stage and worse prognosis than classic HCC (cHCC).…”