Primary Carcinosarcoma and Sarcomatoid Carcinoma of the Liver: Clinical features, Surgical treatment, and Prognosis

Jiong Lu, MD, NanSheng Cheng, MD. Department of Bile Duct Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.

Background and Aim: Primary carcinosarcoma (CS) and sarcomatoid carcinoma (SC) of the liver are extremely rare malignancies composed of both carcinomatous and sarcomatous components. The aim of this study is to clarify the clinical features, sur-gical treatment, and prognosis of patients with primary hepatic CS and SC.

Methods: Between January 1996 and August 2012, 7 and 32 patients were histologi-cally diagnosed as primary hepatic CS and SC, respectively. Their demographic, clinicopathological, and survival data were retrospectively reviewed.

Results: The incidence of primary hepatic CS and SC was 0.8%. There were 30 men (76.9%) and 9 women (23.1%), with a median age of 53 years (range, 29−73 years). Twenty-eight patients (71.8%) were positive for serum HBsAg, and liver cirrhosis was found in 27 patients (69.2%). Nineteen patients (48.7%) underwent radical liver resection, and 15 patients (38.5%) received palliative resection to remove the tumors. The 1-, 2-, and 3-year overall survival (OS) rates were 43.6%, 15.4%, 7.7%, respec-tively. There were no significant differences in the median survival time between the SC and CS group (9.6 vs. 8.2 months, P = 0.641). The patients who received radical resection had obviously better survival compared with those underwent palliative resection or nonsurgical treatment (14.1 vs. 7.1 months, P = 0.001). Univariate analysis revealed that local invasion (P = 0.018), vascular invasion (P = 0.032), Child–Pugh class (P = 0.009), TNM stage (P < 0.001), and radical resection (P = 0.001) were prognostic factors for OS. However, on multivariate analysis, only TNM stage [HR 4.556, 95% CI 1.058–19.620, P=0.042] was identified as independent risk factor of OS.                                                                                                                                     

Conclusion: Both primary hepatic CS and SC are highly aggressive malignancies with extremely poor prognosis. Surgical resection remains the first-choice treatment of these uncommon malignancies, and radical resection at an early stage may contribute to a relatively favorable prognosis.
Key words: carcinosarcoma; sarcomatoid carcinoma; liver

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