Long-term outcomes and prognosis for patients with sarcomatoid hepatocellular carcinoma

Abstract

Background: Characterized by spindle cell composition in hepatocellular carcinoma tumor, sarcomatoid hepatocellular carcinoma (SHC) is a rare malignant with poor prognosis. In this study, we aimed to evaluate the clinical and pathological features of SHC and establish a nomogram that can predict long-term outcomes of the disease.Methods: We retrospectively analyzed 63 patients who were diagnosed with SHC between October 2007and November 2016 and used immunohistochemistry (IHC) to assessed various markers in liver samples.The clinical data and the histological and pathological findings were collected and used to build a nomogram to predict survival. Results:The median overall survival (OS) and the recurrence-free survival (RFS) in SHC were 23.2 and 8.4 months, respectively. High expression levels of tyrosine-protein kinase Met (17/63, 27.0%) were associated with poorer RFS (P=0.040). A panel of markers, consisting heat-shock protein 70 (HSP70), glutamine synthetase (GS), and glypican-3 (GPC3), merged as an independent risk factor for treatment outcomes. The nomogram, which including this panel of markers, predicted OS times with a concordanceindex (C-index) score of 0.758 (95% CI: 0.672-0.843) in the training set and 0.832 (95% CI: 0.712-0.952) in the validation set. The use of the nomogram showed marked improvements in the prediction of patient outcomes compared with conventional staging systems (P<0.05).Conclusions: Diagnosis of SHC is rare and has a relatively poor prognosis. A panel of markers HSP70, GS and GPC3 served as an independent prognostic factor for SHC.

Surgery after combination therapy with a tyrosine kinase inhibitor and anti-PD-1 antibody in sarcomatoid hepatocellular carcinoma: case report and literature review

“…Several studies indicate radical surgical resection to be the most effective treatment for SHC ( 15 , 24 ). A retrospective study that included 63 cases of resected SHC showed the median overall and recurrence-free survival duration to be 23.2 and 8.4 months, respectively; the 1-, 2-, and 3-year overall survival rates were 59.0%, 45.4%, and 34.4%, respectively, and the 1-, 2-, and 3-year recurrence-free survival rates were 36.3%, 26.1%, and 22.4%, respectively ( 25 ). Morisue et al.…”

Hepatocellular carcinoma combined with sarcomatoid hepatocellular carcinoma: A case report

“…Consequently, the aggressive nature of SHC surpasses that of conventional HCC, subsequently leading to an inferior prognosis. [11,12] In this case, our approach encompassed hepatectomy coupled with ultrasound-guided radiofrequency ablation for HCC. Intraoperative ultrasound localization was employed for accurate tumor identification, followed by postoperative hepatic artery embolization to facilitate meticulous tumor resection.…”

A case with sarcomatoid hepatocellular carcinoma and literature review

“…Even if SHC is highly malignant, the pathogenesis of the sarcomatoid transformation remains unknown. The potential risk factors proposed by several previous studies were transarterial embolization, radiofrequency ablation and chronic biliary inflammatory stress [4]. Nevertheless, some individuals still develop SHC even if they do not undergo anticancer therapy [9,10].…”

“…The incidence of SHC varies from 1.8-2.0% in surgically resected cases [2,3]. Previous studies reported that SHC was more likely to occur in patients who received repeated anticancer therapies, including transarterial embolization and radiofrequency ablation [3,4]. Hepatitis, one of the causative factors of hepatocellular carcinoma (HCC), is also considered a risk factor for SHC [5].…”