Background: Hepatocellular carcinoma (HCC) subtypes differ in terms of histopathology and prognosis. Sarcomatoid HCC is rare and literature concerning the survival of patients with sarcomatoid HCC is scarce. Materials and Methods: Data of patients with sarcomatoid HCC, diagnosed from 1989 to 2016, were extracted from the Surveillance, Epidemiology and End Results (SEER) database. We evaluated the baseline and tumor related data, overall survival (OS), disease-specific survival and the performance (Harrell’s concordance index – OS c-index) of the eighth edition of the American Joint Committee on Cancer TNM staging system (AJCC8). In addition, univariate and multivariate forward stepwise cox regression analyses were performed to identify factors associated with increased risk of death. Results: The SEER cohort consisted of 71 patients, mostly males (n=49, 69.0%), of White race (n=51, 71.8%) and the most common stage at presentation was stage IVB (n=30, 42.3%). The overall predictive ability of AJCC8 was mediocre, with an OS c-index=0.577 (SE=0.048). Surgery (hazard ratio=0.25, p<0.001) was significantly associated with reduced risk of death. Advanced TNM stage was not associated with increased risk of death. Conclusion: Sarcomatoid HCC, a rare subtype of HCC, is associated with poor outcomes in terms of overall and disease-specific survival across all disease stages. Surgery seems to be of utmost importance. The eighth edition of the AJCC8 for HCC underperforms in predicting the survival of patients with sarcomatoid subtype.

中文翻译：

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肉瘤样肝细胞癌的流行病学、分期和结局：SEER 人群分析

背景：肝细胞癌 (HCC) 亚型在组织病理学和预后方面存在差异。肉瘤样 HCC 很少见，关于肉瘤样 HCC 患者生存的文献也很少。材料与方法：从监测、流行病学和最终结果 (SEER) 数据库中提取 1989 年至 2016 年诊断的肉瘤样 HCC 患者的数据。我们评估了第八版美国癌症联合委员会 TNM 分期系统 (AJCC8) 的基线和肿瘤相关数据、总生存期 (OS)、疾病特异性生存期和性能（Harrell 一致性指数 - OS c 指数）。此外，还进行了单变量和多变量前向逐步 Cox 回归分析，以确定与死亡风险增加相关的因素。结果：SEER 队列由 71 名患者组成，大多数男性（n=49, 69.0%），白人（n=51, 71.8%），最常见的阶段是IVB期（n=30, 42.3%）。AJCC8 的整体预测能力中等，OS c-index=0.577 (SE=0.048)。手术（风险比=0.25，p<0.001）与死亡风险降低显着相关。晚期 TNM 分期与死亡风险增加无关。结论：肉瘤样 HCC 是一种罕见的 HCC 亚型，与所有疾病阶段的总体和疾病特异性生存率的不良结果相关。手术似乎是最重要的。第八版 AJCC8 for HCC 在预测肉瘤样亚型患者的生存方面表现不佳。AJCC8 的整体预测能力中等，OS c-index=0.577 (SE=0.048)。手术（风险比=0.25，p<0.001）与死亡风险降低显着相关。晚期 TNM 分期与死亡风险增加无关。结论：肉瘤样 HCC 是一种罕见的 HCC 亚型，与所有疾病阶段的总体和疾病特异性生存率的不良结果相关。手术似乎是最重要的。第八版 AJCC8 for HCC 在预测肉瘤样亚型患者的生存方面表现不佳。AJCC8 的整体预测能力中等，OS c-index=0.577 (SE=0.048)。手术（风险比=0.25，p<0.001）与死亡风险降低显着相关。晚期 TNM 分期与死亡风险增加无关。结论：肉瘤样 HCC 是一种罕见的 HCC 亚型，与所有疾病阶段的总体和疾病特异性生存率的不良结果相关。手术似乎是最重要的。第八版 AJCC8 for HCC 在预测肉瘤样亚型患者的生存方面表现不佳。与所有疾病阶段的总体和疾病特异性生存率的不良结果有关。手术似乎是最重要的。第八版 AJCC8 for HCC 在预测肉瘤样亚型患者的生存方面表现不佳。与所有疾病阶段的总体和疾病特异性生存率的不良结果有关。手术似乎是最重要的。第八版 AJCC8 for HCC 在预测肉瘤样亚型患者的生存方面表现不佳。