Objective  To analyze and summarize the clinical and imaging features of hepatocellular carcinosarcoma (HCS) and to illustrate the relationship between the treatment and prognosis of HCS.

  Methods  Data of patients with HCS diagnosed by pathology in Shengjing Hospital of China Medical University from November 2009 to May 2020 were analyzed retrospectively. To summarize the characteristics of HCS, we analyzed the relationship between treatment methods and survival durations.

  Results  A total of 11 patients were included (seven men and four women). The median age was 58 (41-71) years, and the median tumor diameter was 7 (2.0-15.6) cm. Tumors were located in the left half of the liver in two cases and in the right half of the liver in nine cases. Viral hepatitis B was present in nine cases, the alphafetoprotein (AFP) level was >20 ng/mL in two cases, and the carbohydrate antigen 19-9 (CA19-9) level was >40 U/mL in six cases. Imaging showed that all lesions had mixed density, including cystic degeneration in the center of 2 lesions and necrotic area in 4 lesions. The median tumor-free survival duration was 6 (2-87) months, and the median overall survival duration was 12 (3-87) months. The 1-year survival rate was 54.5%, the 3-year survival rate was 36.4%, and the 5-year survival rate was 11.1%. The survival durations in one case applied radical (R0) resection, 10 cases applied palliative resection, one case applied R0 resection, and three cases applied multidisciplinary comprehensive treatment were significantly longer than those in other cases.

  Conclusions  HCS has a low incidence, strong invasiveness, and a poor prognosis. The diagnosis specificity of CA19-9 is higher than those of AFP and carcinoembryonic antigen (CEA). The disease is characterized by necrosis or cystic changes, and is difficult to diagnose before operation. When HCS is confirmed, the probability of carrying out R0 resection is low, and multidisciplinary comprehensive treatment is necessary for improving the outcome of the disease.