Clinical diagnosis and treatment of 14 cases of hepatic sarcomatoid carcinoma

doi:10.3877/cma.j.issn.2095-3232.2025.03.016

Abstract

Abstract:

Objective

To investigate the clinicopathological features， treatment and prognosis of hepatic sarcomatoid carcinoma （HSC）.

Methods

Clinical data of 14 patients with HSC admitted to the First Affiliated Hospital of Guangxi Medical University from March 2002 to March 2022 were retrospectively analyzed. Among them， 12 patients were male and 2 female， aged from 46 to 77 years， with a median age of 56 years. Clinical features， imaging manifestations， pathological findings， treatment and prognosis were summarized and analyzed between two groups. According to different treatment， 14 patients were divided into the surgery（n=9） and non-surgery groups （n=5）. Survival status was compared between two groups. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

The male-to-female ratio was 6∶1.11 patients developed initial symptoms of epigastric discomfort， 1 case of weight loss， and 3 patients were detected during physical examination. 11 cases were with positive HBsAg， 11 cases had a serum ALB level ＜34 g/L and 1 case of TB level ＞17.1 μmol/L， 1 case of AFP level ＞400 μg/L， and 3 cases of CA19-9 level ＞40 kU/L.11 cases were graded as Child-Pugh grade A and 3 cases of grade B. One patient was classified as stageⅠB，5 cases of stage Ⅲ and 8 cases of stage Ⅳ based on the TNM staging system. Among 14 patients， 8 cases had lymph node metastases. Imaging examination detected intratumoral necrosis in 7 cases. Vimentin， CK， P53 and Ki-67 were positive. The follow-up time was 1.0-58.0 months， with a median of 8.5 months. The median overall survival （OS） of 14 patients was 5 months. The median OS of surgery group was 5 months， and 25 months for non-surgery group. There was no statistical difference in OS between two groups （χ²=0.356， P=0.551）.

Conclusions

Clinical manifestations， laboratory and imaging examination of HSC are non-specific， and the diagnosis depends on pathological examination. No significant difference is found between surgical and nonsurgical treatment. Nevertheless， extended radical resection combined with multi-organ resection contributes to improving the quality of life and prolonging the survival time in certain patients.

Key words: Hepatic sarcomatoid carcinoma, Clinical features, Treatment modalities, Prognosis

Weimin Mao, Zhujing Lan, Banghao1 Xu, Hai Zhu, Jilong Wang, Zongrui Jin, Bingcheng Meng, Tingting Lu, Jingjing Zeng, Zili Lyu, Rui Song, Zhang Wen. Clinical diagnosis and treatment of 14 cases of hepatic sarcomatoid carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(03): 435-441.

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References 29

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临床病理因素	非手术组	手术组	统计值	P值
年龄［岁，M（Min～Max）］	55（47～61）	59（46～77）	Z=-0.469	0.639
性别（例，男/女）	4/1	8/1	-	＞0.999
HBsAg阳性（例）	3	8	-	0.505
AFP＞400 μg/L（例）	0	1	-	＞0.999
CA19-9＞40 kU/ L（例）	1	2	-	＞0.999
CEA＞5 μg/L（例）	0	0	-	＞0.999
TB＞17.1 μmol/L（例）	1	0	-	0.357
ALB＜34 g/L（例）	4	6	-	＞0.999
Child-Pugh分级A级（例）	5	6	-	0.258
肿瘤直径［cm，M（Min～Max）］	7.4（3.3～16.0）	11.0（3.0～16.0）	Z=-1.070	0.285
肿瘤多发（例）	3	2	-	0.266
肿瘤部位（例）			-	0.021
肝右叶	2	3
肝左叶	0	5
尾状叶	0	1
两叶	3	0
肝硬化（例）	5	7	-	0.505
淋巴结转移（例）	3	5	-	＞0.999
癌组织来源（例）			-	＞0.999
肝细胞癌	4	7
胆管细胞癌	1	2
TNM分期（例，Ⅰ、Ⅱ/Ⅲ、Ⅳ）	1/4	0/9	-	0.357

临床病理因素	非手术组	手术组	统计值	P值
年龄［岁，M（Min～Max）］	55（47～61）	59（46～77）	Z=-0.469	0.639
性别（例，男/女）	4/1	8/1	-	＞0.999
HBsAg阳性（例）	3	8	-	0.505
AFP＞400 μg/L（例）	0	1	-	＞0.999
CA19-9＞40 kU/ L（例）	1	2	-	＞0.999
CEA＞5 μg/L（例）	0	0	-	＞0.999
TB＞17.1 μmol/L（例）	1	0	-	0.357
ALB＜34 g/L（例）	4	6	-	＞0.999
Child-Pugh分级A级（例）	5	6	-	0.258
肿瘤直径［cm，M（Min～Max）］	7.4（3.3～16.0）	11.0（3.0～16.0）	Z=-1.070	0.285
肿瘤多发（例）	3	2	-	0.266
肿瘤部位（例）			-	0.021
肝右叶	2	3
肝左叶	0	5
尾状叶	0	1
两叶	3	0
肝硬化（例）	5	7	-	0.505
淋巴结转移（例）	3	5	-	＞0.999
癌组织来源（例）			-	＞0.999
肝细胞癌	4	7
胆管细胞癌	1	2
TNM分期（例，Ⅰ、Ⅱ/Ⅲ、Ⅳ）	1/4	0/9	-	0.357

例序	治疗方式
1	腹腔镜下尾状叶切除
2	S4部分切除+膈肌部分切除
3	S4部分切除
4	左半肝切除+心包部分切除+膈肌切除+胃部分切除
5	S2+S3切除
6	左半肝切除术
7	左半肝切除+膈肌部分切除
8	右半肝切除+膈肌部分切除+肾上腺部分切除
9	右半肝切除
10	超声引导下无水酒精注射术
11	TAE
12	卡培他滨+卡瑞利珠单抗+阿帕替尼
13	对症支持治疗
14	微波消融

例序	治疗方式
1	腹腔镜下尾状叶切除
2	S4部分切除+膈肌部分切除
3	S4部分切除
4	左半肝切除+心包部分切除+膈肌切除+胃部分切除
5	S2+S3切除
6	左半肝切除术
7	左半肝切除+膈肌部分切除
8	右半肝切除+膈肌部分切除+肾上腺部分切除
9	右半肝切除
10	超声引导下无水酒精注射术
11	TAE
12	卡培他滨+卡瑞利珠单抗+阿帕替尼
13	对症支持治疗
14	微波消融

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