Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population‐based analysis

Abstract

Few data are available regarding the management and outcomes among patients with sarcomatoid hepatocellular carcinoma (HCC) due to its rarity. 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. 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 (8.5cm vs 5.4cm; P<.001) and poorly or undifferentiated tumors (52.9% vs 13.8%; P<.001) compared with patients who hadconventional 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 patientstreated with eithercurative-intent or palliative therapies. Stage-specific subgroup analysis indicated a worse OS amongpatients 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 independentlyassociated with worse outcomes (all P<.05). Sarcomatoid HCC is a very rare variant of HCC, which wasassociated 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 hada worse stage-for-stage long-term survival compared with patients who had conventional HCC.