Clinical outcomes of rare hepatocellular carcinoma variants compared to pure hepatocellular carcinoma

• Type of Material: Article
• Authors: Katerina Zakka, Emory University; Renjian Jiang, Emory University; Olatunji Alese, Emory University; Walid Shaib, Emory University; Christina Wu, Emory University; Joel Wedd, Emory University; Marty Thomas Sellers, Emory University; Madhusmita Behera, Emory University; Bassel El-Rayes, Emory University; Mehmet Akce, Emory University
• Language: English
• Date: 2019-01-01
• Publisher: Dove Medical Press
• Publication Version: Final Published Version
• Copyright Statement: © 2019 Zakka et al.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.2147/JHC.S215235
• Title of Journal or Parent Work: Journal of Hepatocellular Carcinoma
• ISSN: 2253-5969
• Volume: 6
• Start Page: 119
• End Page: 129
• Grant/Funding Information: Research reported in this publication was supported in part by the Winship Research Informatics Shared Resource of Winship Cancer Institute of Emory University and NIH/NCI under award number P30CA138292.
• Keywords: TRANSPLANTATION; hepatocellular carcinoma; hepatocellular carcinoma variants; treatment; CHOLANGIOCARCINOMA; Oncology; TUMOR; outcome; Life Sciences & Biomedicine; Science & Technology; PROGNOSIS; LIVER; NATURAL-HISTORY; SORAFENIB; FIBROLAMELLAR CARCINOMA
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology

Abstract

Background: HCC variants are rare primary hepatic tumors. The aim of this study is to compare clinical characteristics and outcomes of HCC variants with pure HCC. Methods: Patients diagnosed between 2004 and 2013 with ICD-O-3 8180/3 and 8170/3-8175/3 were identified from the National Cancer Database. Univariate and multivariate survival analyses were conducted to analyze the association between histology and overall survival (OS). Results: 80,280 patients were identified; pure HCC 78,461 (97.7%), fibrolamellar (FLHCC) 310 (0.4%), scirrhous 161 (0.2%), spindle cell 72 (0.1%), clear cell 487 (0.6%), pleomorphic 23 (0.0%), and combined HCC and cholangiocarcinoma (mixed HCC) 766 (1.0%). 76.7% were male and 72% Caucasian. Liver transplant was performed in 10.1% of pure HCC, 14.5% of mixed HCC, 16.2% of scirrhous, 6.9% of spindle cell, 8.8% of clear cell, 8.7% of pleomorphic, and 3.2% of FLHCC (p<0.001). Pure HCC (10.6%) underwent surgical resection without transplant less often than variants except for scirrhous (9.9%) (p<0.001). More than a third of patients in each histological type received chemotherapy. FLHCC had the best 5-year OS (38.7%), spindle cell and pleomorphic had the worst (9.6% and 13.0%). In multivariate analysis stratified by histology variants, chemotherapy was associated with improved OS in all histologies except for scirrhous and pleomorphic HCC. Conclusion: HCC variants underwent surgical resection more often than pure HCC. FLHCC had the best 5-year OS. Liver transplant was commonly performed in HCC variants.