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Li C, Lei Q, Ju P, Liu J, Deng W, Chen L. Effect of trans-theoretical model-based nursing intervention on emotion and fear in post-liver cancer surgery patients. Am J Transl Res 2024; 16:2346-2357. [PMID: 39006267 PMCID: PMC11236662 DOI: 10.62347/myea6043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/23/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To investigate the efficacy of nursing interventions grounded in the trans-theoretical model on emotion and fear among patients undergoing surgery for hepatocellular carcinoma (HCC). METHODS The study included 188 surgical patients from the Second People's Hospital of Lanzhou City who underwent HCC intervention between March 2020 and May 2022. The control group comprised 81 patients receiving standard postoperative care, while the observation group included 107 patients who received nursing interventions based on the trans-theoretical model. We assessed outcomes using the Fear of Progression Questionnaire-Short Form (FOP-Q-SF), Quality of Life Questionnaire Core 30 (QLQ-C30), Gastrointestinal Comfort Questionnaire (GCQ), Self-Rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) before and after the intervention. Logistic regression was used to identify factors influencing post-intervention fear. RESULTS Both groups showed improvement in FOP-Q-SF, QLQ-C30, GCQ, SAS, and SDS scores after the intervention. However, the observation group demonstrated significantly greater improvements (P < 0.05). There was a positive correlation between FOP-Q-SF scores and both SAS and SDS scores (all P < 0.05), and a negative correlation with QLQ-C30 and GCQ scores (both P < 0.05). Multifactorial logistic regression revealed that age (P < 0.001, OR: 8.328), gender (P < 0.001, OR: 0.181), literacy level (P < 0.001, OR: 0.354), and nursing care regimen (P < 0.001, OR: 0.078) were significant independent risk factors for persistence of fearpost-intervention. CONCLUSION The implementation of nursing interventions based on the trans-theoretical model significantly reduces postoperative fear and anxiety, improves pain perception, and enhances overall comfort in patients after liver cancer surgery.
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Affiliation(s)
- Caihong Li
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Qingfen Lei
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Ping Ju
- Department of Gastroenterology, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Junlan Liu
- Department of Hepatology II, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Wenmin Deng
- Department of Gastroenterology, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
| | - Li Chen
- Department of Endoscopy Center, The Second People's Hospital of Lanzhou City No. 388 Jingyuan Road, Chengguan District, Lanzhou 730046, Gansu, China
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Epidemiological Study of Hepatopancreatobiliary Sarcoma in Iran, 2010 - 2014. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2023. [DOI: 10.5812/ijcm-118444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Hepatopancreatobiliary (HPB) malignancies are a relatively rare but important type of cancer with usually poor prognosis. Prompt diagnosis and treatment are crucial to improving the patient’s outcome. For this issue, acknowledgment of epidemiological characteristics is helpful. Objectives: In this study, the epidemiological characteristics of cases with HPB sarcoma among Iranian patients were assessed. Methods: In this epidemiological study, 133 consecutive cases with HPB sarcoma in Iran from 2010 to 2014 were evaluated, including gallbladder, pancreas, hepatic, pancreatic body and head, and other biliary tumors. Results: Nine gallbladder sarcoma cases were reported between 2010 and 2014, accounting for 6.7% of all HPB sarcoma cases, and leiomyosarcoma was the most common. A total of 16 patients of pancreatic origin were reported during this period, with the highest rate of 6 cases in 2011; in this sarcoma category, malignant type spindle cell tumor was the most common type accounting for 12.5% of all cases. Ninety-five cases of liver sarcomas were reported generally. Non-specified and desmoplastic small round cell tumors were the most common types. Five cases of pancreatic head sarcomas were reported during 2010 - 2013. There was no predominant tumor type. Five cases of pancreatic head sarcoma were reported during 2010 - 2013. There was no dominant tumor type. About the other biliary tract sites, six patients were reported. Gastrointestinal stromal sarcoma was the most common type. Conclusions: Hepatopancreatobiliary sarcoma in the Iranian population generally has diverse types, and there are different patterns according to the age and sex distribution in patients according to the initial location of the tumor and also their pathological subtypes.
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Lu T, Yang W, Liu X, Yang X, Yang C, Di W. Imaging Findings of Hepatic Ewing's Sarcoma on Computed Tomography and Gadobenate Dimeglumine-enhanced Magnetic Resonance Imaging: A Case Report and Literature Review. J Clin Transl Hepatol 2022; 10:564-569. [PMID: 35836756 PMCID: PMC9240243 DOI: 10.14218/jcth.2021.00129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 07/02/2021] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
Ewing's sarcoma (ES) is a tumor that often occurs in the long bones and rarely arises from visceral organs primarily. Here, we report a case of primary hepatic ES, discuss its computed tomography (CT) and gadobenate dimeglumine-enhanced magnetic resonance (MRI) features. This is the first Chinese and fifth primary hepatic ES case reported, based on a literature review. Imaging examinations showed that the tumor was solid, with necrosis and hemorrhage. Contrast-enhanced images showed that the tumor was hypervascular and especially had heterogeneous signal intensity on hepatobiliary phase MRI images. Intratumoral vessels and vascular invasion were also present.
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Affiliation(s)
- Tao Lu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Wenhao Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xingchao Liu
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
| | - Xudan Yang
- Department of Pathology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chong Yang
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
| | - Wenjia Di
- Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China
- Correspondence to: Wenjia Di and Chong Yang, Organ Transplantation Center, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 611731, China. ORCID: https://orcid.org/0000-0002-0060-706X (CY). Tel: +86-28-8739-3707, Fax: +86-28-8778-5585, E-mail: (WD), (CY)
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SMARCA4-deficient rectal carcinoma with a sarcomatoid component: a case report. Clin J Gastroenterol 2022; 15:419-426. [PMID: 35129794 DOI: 10.1007/s12328-022-01602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/30/2022] [Indexed: 10/19/2022]
Abstract
A new classification of SMARCA4-deficient tumors was proposed recently for thoracic malignancies, and the tumors have some histopathological characteristics similar to those of carcinosarcoma. We encountered a case of SMARCA4-deficient rectal carcinoma with a sarcomatoid component. A 46-year-old man presented to our hospital with a prolapsing anal mass. Colonoscopy revealed an irregular, nodular, and elevated lesion in the rectum, and the biopsy revealed a moderately differentiated adenocarcinoma. Abdominoperineal resection of the rectum was performed. A macroscopic image of the resected specimen showed a complex tumor 3.5 cm × 3 cm in size with a papillary protrusion and an irregular ulcerative lesion. Histopathological examination revealed that the tumor was composed of moderately/poorly differentiated adenocarcinoma and atypical spindle cells. The adenocarcinoma component was positive for epithelial markers (AE1/AE3 and carcinoembryonic antigen) and showed deletion of SMARCA2 and SMARCA4, while the spindle cells expressed mesenchymal markers (α-smooth muscle actin and vimentin). The pathological diagnosis was poorly differentiated adenocarcinoma with a sarcomatoid component, pT3N2bM0, stage IIIc. Although our case had histological characteristics of carcinosarcoma, immunostaining revealed a deficiency of SMARCA4. This case presented a SMARCA4-deficient colorectal carcinoma with a sarcomatoid component, which was histopathologically similar to carcinosarcoma.
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Liang Z, Han J, Tuo H, Wang Z, Peng Y. Rare primary hepatic carcinosarcoma composed of hepatocellular carcinoma, cholangiocarcinoma, and sarcoma: a case report. J Int Med Res 2021; 49:3000605211050539. [PMID: 34637352 PMCID: PMC8516393 DOI: 10.1177/03000605211050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Primary hepatic carcinosarcoma (HCS) is an extremely rare malignant tumor of the liver that contains carcinomatous and sarcomatous components. The diagnosis, treatment, and prognosis of HCS pose great challenges to clinicians. Herein, we present a case of HCS in a 67-year-old man with unique pathological manifestation. Preoperative magnetic resonance imaging showed a malignant lesion in the right liver and a small sub-focus in the left liver. Radical treatment was performed, including excision of the right posterior lobe of the liver, thrombectomy of the right posterior portal vein, and radiofrequency ablation of lesions in the left liver. The specimens were confirmed to be HCS by pathological examinations, which revealed a combination of poorly differentiated hepatocellular carcinoma, moderately differentiated cholangiocellular carcinoma, and spindle cell sarcoma. Transhepatic arterial chemotherapy and embolization was performed after surgery. Unfortunately, pulmonary metastasis occurred 1.5 months later, which meant a poor prognosis. In this report, we discuss the clinicopathological characteristics of this case and factors that affected surgical outcomes, which may add some ideas for the future diagnosis and treatment of HCS patients.
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Affiliation(s)
- Ze Liang
- Department of Hepatobiliary, Pancreatic, and Splenic Surgery, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, China
| | - Jingzhao Han
- Department of Hepatobiliary, Pancreatic, and Splenic Surgery, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, China
| | - Hongfang Tuo
- Department of Hepatobiliary, Pancreatic, and Splenic Surgery, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, China
| | - Zepu Wang
- Department of Hepatobiliary, Pancreatic, and Splenic Surgery, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, China
| | - Yanhui Peng
- Department of Hepatobiliary, Pancreatic, and Splenic Surgery, 117872Hebei General Hospital, Hebei General Hospital, Shijiazhuang, China
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Huang L, Lu L. Case Report: Review of CT Findings and Histopathological Characteristics of Primary Liver Carcinosarcoma. Front Genet 2021; 12:638636. [PMID: 34220928 PMCID: PMC8248484 DOI: 10.3389/fgene.2021.638636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The aim of the present study was to describe the computed tomography (CT) characteristics of primary liver carcinosarcoma (PLCS) and to explore the pathological basis for the diagnosis of primary hepatocellular carcinoma sarcoma. Methods: Three male patients with PLCS were included in the present retrospective research, and the age was ranged from 52 to 63 years. The plain CT scan and third-stage enhancement scan were performed on patients. The pathological characteristics were analyzed. Stomachache was the main clinical symptoms of the three patients. Cirrhosis background was confirmed in one patients, and chronic Hepatitis B background was confirmed in other two patients. Results: According to the results of CT, the inner diameter of the tumors ranged from 8.6 to 27.0 cm. The fibrous pseudocapsule around the tumor tissues was observed in two patients. Tumor tissues from all three patients were composed of sarcomatous and carcinomatous components. For carcinomatous components, hepatocellular carcinoma was observed in one patient and cholangiocarcinoma was observed in the other two patients. For sarcomatous components, angiosarcoma was observed in two patients and malignant fibrous histiocytoma was observed in another one patient. The tumor tissues were visualized as heterogeneous low density with large sheets of necrotic cystic lesions or thick-walled areas of multilocular cystic lesions using the plain CT scan. Edge-to-center filling and strengthening lesions, mild to moderate enhanced parenchyma at the arterial phase, and isodensity between the tumor parenchyma and the surrounding liver parenchyma at the portal vein phase or delayed phase were observed using the third-stage enhancement scan. Conclusions: CT characteristics observed in the present study were of great benefit for the diagnosis of PLCS.
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Affiliation(s)
- Lu Huang
- Department of Infectious Diseases, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Lijian Lu
- Department of Radiology, The Wuming Affiliated Hospital of Guangxi Medical University, Nanning, China
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Bin F, Chen Z, Liu P, Liu J, Mao Z. The Clinicopathological and Imaging Characteristics of Primary Hepatic Carcinosarcoma and a Review of the Literature. J Hepatocell Carcinoma 2020; 7:169-180. [PMID: 33117751 PMCID: PMC7568615 DOI: 10.2147/jhc.s272768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/10/2020] [Indexed: 12/28/2022] Open
Abstract
Purpose To improve the understanding of hepatic carcinosarcoma (HCS) by analyzing radiological imaging data and clinicopathological features. Materials and Methods A retrospective analysis was performed on four patients with HCS confirmed immunohistochemically. The analysis included three males and one female, aged 29 to 64 years. Four patients underwent computed tomography (CT) scans, and one underwent magnetic resonance imaging (MRI) scans simultaneously. Results Three patients had a history of hepatitis B, cirrhosis or fibrosis, and two patients had schistosomiasis. Two cases tested positive for elevated serum carbohydrate antigen (CA) 19–9. The maximum diameters of the lesions ranged from 7.8 to 9.0cm. Pathologically, the carcinomatous and sarcomatous elements in two patients could not be classified, one of the patients had cholangiocellular carcinoma (CCC) and undifferentiated sarcoma, the other had hepatocellular carcinoma (HCC) and undifferentiated pleomorphic sarcoma (UPS). All tumors showed heterogeneous density/intensity, accompanied by vast cystic changes and necrosis, with two cases having cystic septations. Capsule formation was not identified. The margins of the radiological images showed irregular ring enhancement. One case presented continuous progressive enhancement, one case with “fast in fast washout” and two cases with “fast in late washout”. Lymphonodus metastasis, satellite nodules, vascular embolism, and organ invasion (hepatic flexure of the colon) were identified. Conclusion HCS is a rare, high-grade malignancy with poor prognosis. The preoperative diagnosis is expected to improve by carefully analyzing the imaging features of the patients in combination with their clinical characteristics. Radical resection and postoperative chemoradiotherapy can improve the survival rate of patients.
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Affiliation(s)
- Fengli Bin
- Department of Radiology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China
| | - Zhihong Chen
- Department of Pathology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China
| | - Peng Liu
- Department of Radiology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China
| | - Jianbin Liu
- Department of Radiology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China
| | - Zhiqun Mao
- Department of Radiology, Hunan Provincial People's Hospital, First Affiliated Hospital of Hunan Normal University, Changsha, Hunan Province, People's Republic of China
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Primary hepatic malignant vascular tumors: a follow-up study of imaging characteristics and clinicopathological features. Cancer Imaging 2020; 20:59. [PMID: 32795351 PMCID: PMC7427980 DOI: 10.1186/s40644-020-00336-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background Owing to its low incidence, there is insufficient clinical awareness and diagnostic experience with primary hepatic malignant vascular tumors (PHMVTs). The aim of our study was to investigate the imaging and clinicopathological features of patients with PHMVTs and analyze the clinicopathological correlations. Methods We retrospectively analyzed 42 patients who had pathologically confirmed PHMVT during the period from June 2012 to December 2019 and enrolled them in our study. The computed tomography (CT) and magnetic resonance (MR) images and pathological findings of each patient were recorded. Results There were more female (29/42) than male patients. The imaging features of primary hepatic angiosarcoma (PHA) (n = 11) included ill-defined margins (11/11, 100%), necrosis (5/11, 45%), calcification (3/11, 27%) and “slow in-slow out” centripetal enhancement (7/11, 64%). Patients with epithelioid hemangioendothelioma (EHE) (n = 15) presented with ill-defined margins (15/15, 100%), necrosis (6/15, 40%), calcification (2/15, 13%), “fast in-slow out” centripetal enhancement (10/15, 67%), halo sign (15/15, 100%), pseudocapsule sign (4/15, 27%), lollipop sign (2/15, 13%) and capsule retraction sign (2/15, 13%). Patients with malignant hemangiopericytoma (MHP) (n = 3) showed ill-defined margins (3/3, 100%), necrosis (3/3, 100%) and “fast in-slow out” progressive enhancement (3/3, 100%). Infantile hemangioendotheliomas (IHEs) (n = 13) were defined by ill-defined margins (7/13, 54%), necrosis (8/13, 62%), calcification (5/13, 38%) and “fast in-slow out” centripetal enhancement (13/13, 100%). Immunohistochemistry showed strong positive expression of CD31, CD34, ERG, FaVIII and FLI-1. Patients with IHE (96 months) and EHE (88 months) had the longest survival times, followed by those with MHP (23 months), while patients with PHA (15 months) had the shortest survival time. Conclusion On CT and MR images, most PHMVTs were ill-defined, heterogeneous, hypervascular masses with centripetal progressive enhancement and possibly calcification, especially in female patients. The prognosis of patients with PHMVT was associated with the pathological type of the tumor.
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Zhao L, Yang Y, Gao Q. Efficacy and safety of nivolumab plus apatinib in advanced liver carcinosarcoma: a case report. Immunotherapy 2020; 11:651-656. [PMID: 31088237 DOI: 10.2217/imt-2018-0214] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Liver carcinosarcoma is a rare malignancy usually seen in adults, majority of whom have a history of chronic hepatitis. Radical resection in early stages leads to better prognosis; however, the treatment regimen for patients at advanced stage is usually based on previously published case reports. At present, there is no report on programmed death-1 blockade and liver carcinosarcoma. Here, we report the case of a patient with advanced liver carcinosarcoma treated with nivolumab plus apatinib, which resulted in partial remission. However, grade 3 elevation of aminotransferase occurred during treatment, suggesting that the combination therapy should be recommended only after risk assessment. Nonetheless, programmed death-1 blockade plus apatinib might be a promising therapeutic approach for patients with advanced liver carcinosarcoma.
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Affiliation(s)
- Lingdi Zhao
- Department of Immunotherapy, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Yonghao Yang
- Department of Immunotherapy, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
| | - Quanli Gao
- Department of Immunotherapy, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, Henan Province, China
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Wu L, Tsilimigras DI, Farooq A, Hyer JM, Merath K, Paredes AZ, Mehta R, Sahara K, Shen F, Pawlik TM. Management and outcomes among patients with sarcomatoid hepatocellular carcinoma: A population-based analysis. Cancer 2019; 125:3767-3775. [PMID: 31299092 DOI: 10.1002/cncr.32396] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/04/2019] [Accepted: 06/19/2019] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Lu Wu
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.,Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Diamantis I Tsilimigras
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Ayesha Farooq
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - J Madison Hyer
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Katiuscha Merath
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Anghela Z Paredes
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Rittal Mehta
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Kota Sahara
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
| | - Feng Shen
- Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio
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Liao SH, Su TH, Jeng YM, Liang PC, Chen DS, Chen CH, Kao JH. Clinical Manifestations and Outcomes of Patients with Sarcomatoid Hepatocellular Carcinoma. Hepatology 2019; 69:209-221. [PMID: 30014620 DOI: 10.1002/hep.30162] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/20/2018] [Indexed: 12/15/2022]
Abstract
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related deaths worldwide. Sarcomatoid HCC is a rare histological subtype of HCC with largely unclear clinical manifestations and outcomes. We evaluated the clinical manifestations and outcomes of patients with sarcomatoid HCC. We identified 5,047 patients with histologically proven HCC from the Cancer Registry Database (1996-2016) of National Taiwan University Hospital. Among them, 40 patients with sarcomatoid HCC were identified from the pathology database of National Taiwan University Hospital. We included 160 patients with nonsarcomatoid HCC through propensity score matching according to sex, age, and Barcelona Clinic Liver Cancer stage. The majority of these patients with sarcomatoid HCC were men (75%); their median age was 58 years. Only 47.5% of the patients with sarcomatoid HCC presented with typical image patterns of HCC. The pathological grading of sarcomatoid HCC was more advanced compared with that of nonsarcomatoid HCC (42.5% vs. 23.8% in grade III and IV, P < 0.0001). The sarcomatoid group had significantly shorter median recurrence-free (13.3 vs. 84.2 months, log-rank P < 0.0001) and overall (8.3 vs. 69.3 months, log-rank P < 0.0001) survival than did the nonsarcomatoid group. The results of the multivariable Cox proportional hazard model revealed histological sarcomatoid subtype as an independent factor for all-cause mortality (hazard ratio [HR], 6.47; 95% confidence interval [CI], 3.12-13.43; P < 0.0001) and tumor recurrence (HR, 4.08; 95% CI, 1.72-9.66; P = 0.001). Conclusion: Compared with nonsarcomatoid HCC, sarcomatoid HCC was associated with more advanced histological grades and atypical image patterns. Histological sarcomatoid subtype is an independent predictor of tumor recurrence after curative treatment and all-cause mortality in patients with HCC.
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Affiliation(s)
- Sih-Han Liao
- National Taiwan University Cancer Center, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Tung-Hung Su
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Jeng
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Po-Chin Liang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Shinn Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin County, Taiwan.,National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jia-Horng Kao
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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Shi D, Ma L, Zhao D, Chang J, Shao C, Qi S, Chen F, Li Y, Wang X, Zhang Y, Zhao J, Li H. Imaging and clinical features of primary hepatic sarcomatous carcinoma. Cancer Imaging 2018; 18:36. [PMID: 30314525 PMCID: PMC6186076 DOI: 10.1186/s40644-018-0171-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 10/02/2018] [Indexed: 12/13/2022] Open
Abstract
Background Primary hepatic sarcomatous carcinoma (PHSC) is a rare malignancy composed of both carcinomatous (either hepatocellular or cholangiocellular) and sarcomatous components. The purpose of our study was to evaluate the imaging and clinical findings of PHSCs, improving the understanding and diagnosis of tumors. Methods We retrospectively reviewed the imaging and clinical findings of ten patients with pathologically proven PHSCs, including two cases of sarcomatous intrahepatic cholangiocarcinoma (S-ICC), seven cases of sarcomatous hepatocellular carcinoma (S-HCC) and one case of sarcomatous combined hepatocellular and cholangiocarcinoma (S-HCC–CC). Six patients underwent computed tomography (CT) scans and five underwent magnetic resonance imaging (MRI) scans with one of them having both CT and MRI scans. Results Eight of ten patients had a background of chronic hepatitis or cirrhosis. The elevation of alpha-fetoprotein (AFP) was positive in half of the patients. All the tumors were located near the liver subcapsular area and six of ten cases were massive with round or oval shapes and ill-defined. The lesion textures were mainly heterogeneous in eight tumors for the necrosis or hemorrhage. Eight tumors showed hypo-enhancement and nine tumors exhibited initial peripheral rim (five cases) or heterogeneous (four cases) enhancement, followed by progressive (six cases) and peripheral or partial washout (three cases) on the later phases. Of the seven surgically resected tumors, five showed liver capsular invasion with one of them rupturing into the perihepatic space. Vascular thrombosis (five cases), intrahepatic metastasis (four cases), adjacent organ invasion or seeding (three cases), and lymph node metastasis (four cases) were found on imaging or in pathology. The follow-up period ranged from one to 36 months. Four patients with T3-T4 staging died from recurrence and metastasis between 2 and 5 months, and three patients with T1 staging did not have any recurrence between 16 and 24 months. Conclusion PHSC generally presents as a subcapsular mass with hypovascularity and may be characterized by rim-like or heterogeneous enhancement on the arterial phase and a progressive dynamic pattern. These tumors usually coincide with chronic hepatitis or cirrhosis and poor prognosis appears to be associated with TNM staging.
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Affiliation(s)
- Dongli Shi
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Liang Ma
- Center of Interventional Oncology and Liver Diseases, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Dawei Zhao
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Jing Chang
- Department of pathology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Chen Shao
- Department of pathology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Shi Qi
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Feng Chen
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Yunfang Li
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Xing Wang
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Yanyan Zhang
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Jing Zhao
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China
| | - Hongjun Li
- Department of Diagnostic Radiology, Beijing You'an Hospital, Capital Medical University, No.8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China.
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