Sarcomatoid hepatocellular carcinoma versus conventional hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

Background: Sarcomatoid hepatocellular carcinoma (SHCC) is a rare subtype of primary liver malignancies and is still ill-defined and poorly understood. Therefore, our study was performed to have a comprehensive evaluation SHCC versus conventional hepatocellular carcinoma (HCC).

Methods: A thorough database searching was performed in PubMed, EMBASE and the Cochrane Library. RevMan5.3 and Stata 13.0 software were used for statistical analyses. The primary endpoint of our analysis is the long-term survival and the secondary endpoint is clinical and pathological features.

Results: Four studies with a relative large cohort were finally identified. Compared with patients with pure HCC, patients with SHCC had a significantly worse overall survival (P < 0.00001) and disease-free survival (P < 0.0001). Moreover, a larger tumor size (P = 0.003), a higher incidence of node metastasis (P < 0.00001) and a higher proportion of advanced lesions (P = 0.04) were more frequently detected in patients with SHCC. Higher levels of serum ALT (P = 0.02) and TB (P = 0.005) were detected in patients with HCC rather than SHCC, while serum ALB (P = 0.02) level was relatively higher in patients with SHCC. For other measured outcomes, including concurrent viral hepatitis, liver cirrhosis, liver storage (Child A/B), multifocal tumors, vascular invasion and preoperative AFP level, the results showed no significant difference (P > 0.05).

Conclusion: SHCC has a worse prognosis and exhibits more aggressively than conventional HCC. Future large well-designed studies are demanded for further validation.

Keywords: Hepatocellular carcinoma; Prognosis; Sarcomatoid hepatocellular carcinoma.

Fig. 1

The specific process of literature searching and selection

Fig. 2

Forest plots presenting the clinical features between patients with SHCC and patients with pure HCC. A Concurrent HBV infection, B concurrent HCV infection, C concurrent liver cirrhosis, D preoperative liver function (Child A/B); E total serum bilirubin level; F alanine transaminase, G albumin, H the number of patients with preoperative AFP level > 20 ng/ml

Fig. 3

Forest plots presenting the tumor pathological features between patients with SHCC and HCC. A Tumor size, B tumor number (multiple), C tumor differentiation status (poorly or undifferentiated), D node metastasis, E vascular invasion

Fig. 4

Forest plots presenting the long-term survival between patients with SHCC and HCC. A OS, B DFS