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[A clinicopathological and prognostic study of rare pathological subtype cases of hepatocellular carcinoma]
1Department of Abdominal Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100021, China.
Objective:
To investigate the clinicopathological features and prognosis of clear cell carcinoma (CCC), giant cell carcinoma (GCC) and sarcomatoid carcinoma (SC), the 3 rare cellular morphological subtypes of hepatocellular carcinoma (HCC).
Methods:
The clinic data of 78 rare pathological subtype HCC cases, which were diagnosed by postoperative pathological examination during October 1998 and June 2013 was analyzed retrospectively. CCC group involved 43 patients (33 male and 10 female), with a median age of 56 years (ranging from 25 to 80 years). GCC group involved 19 patients (16 male and 3 female), with a median age of 59 years (ranging from 38 to 66 years). SC group involved 16 patients (14 male and 2 female), with a median age of 57 years (ranging from 46 to 70 years). Characteristic differences were analyzed by χ(2) test and Fisher exact test. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in survival multivariate analysis.
Results:
The proportion of multiple lesions in CCC group (4.7%) was significantly lower than those in GCC group (21%) or SC group (25%) (P = 0.034). The histologic grade of CCC group was the best, whereas SC group was the worst (P = 0.000). The survival analysis revealed that median survival time and the 1-, 3-, 5-year survival rates for the 3 groups are CCC group (45 months, 92%, 65%, 45%) > GCC group (13 months, 55%, 30%, 0) > SC group (8 months, 31%, 0, 0), respectively (χ(2) = 4.473 to 26.981, P < 0.05, between each 2 groups). Two cases in CCC group underwent abdominal metastasectomy 18 and 32 months after hepatectomy, and they still achieved long-term survival time. The histologic grade of tumor cell and the TNM staging were 2 independent unfavorable prognostic factors (regression coefficient: 4.038 and 1.354, P < 0.05).
Conclusion:
CCC is a rare low degree malignancy pathological subtype of HCC and may achieve a relatively optimistic prognosis. However, the GCC, especially SC are 2 rare high degree malignancy pathological subtypes of HCC with highly aggressive and poor prognosis.
