Premium
Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population‐based analysis
Author(s) -
Wu Lu,
Tsilimigras Diamantis I.,
Farooq Ayesha,
Hyer J. Madison,
Merath Katiuscha,
Paredes Anghela Z.,
Mehta Rittal,
Sahara Kota,
Shen Feng,
Pawlik Timothy M.
Publication year - 2019
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.32396
Subject(s) - medicine , sarcomatoid carcinoma , hepatocellular carcinoma , stage (stratigraphy) , propensity score matching , oncology , cancer , cohort , confounding , subgroup analysis , gastroenterology , carcinoma , meta analysis , paleontology , biology
Background Few data are available regarding the management and outcomes among patients with sarcomatoid hepatocellular carcinoma (HCC) due to its rarity. Methods Patients diagnosed with sarcomatoid HCC from 2004 through 2015 were identified in the National Cancer Data Base. Overall survival (OS) was calculated among patients with sarcomatoid versus conventional HCC using a 1:3 propensity score matching based on sex, age, and American Joint Committee on Cancer (AJCC) stage of disease. Results The final analytic cohort included 104 patients with sarcomatoid HCC and 312 patients with conventional HCC. Patients with sarcomatoid HCC more often had a larger median tumor size (8.5 cm vs 5.4 cm; P < .001) and poorly or undifferentiated tumors (52.9% vs 13.8%; P < .001) compared with patients who had conventional HCC. 5‐year OS was worse among patients with sarcomatoid versus conventional HCC (5.7% vs 30.1%; P < .001). Subgroup analysis demonstrated worse 5‐year OS among patients with sarcomatoid versus conventional HCC among patients treated with either curative‐intent or palliative therapies. Stage‐specific subgroup analysis indicated a worse OS among patients with AJCC stage I, stage II, or stage III sarcomatoid HCC. On multivariable analysis, uninsured status, advanced AJCC stage (stage III/stage IV), and histological sarcomatoid subtype were independently associated with worse outcomes (all P < .05). Conclusions Sarcomatoid HCC is a very rare variant of HCC, which was associated with larger tumor size and worse tumor grade on presentation. On propensity score matched analyses that controlled for known confounding factors, patients with sarcomatoid HCC had a worse stage‐for‐stage long‐term survival compared with patients who had conventional HCC.