Impact of sex on the survival of patients with hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results analysis

Abstract

BACKGROUND: Men are 4 to 8 times more likely to develop hepatocellular carcinoma (HCC) than women. Preclinical models have suggested a role for sex hormones in the development of HCC. In the current study, the authors investigated the impact of age, sex, race, and ethnicity on the survival of patients with HCC using the Surveillance, Epidemiology, and End Results (SEER) database. METHODS: Patients diagnosed with HCC from 1988 through 2010 were identified from the SEER registry. Hazard ratios (HR) for overall survival (OS) were derived using the Cox regression model adjusted for race, year of diagnosis, marital status, treatment, birthplace, tumor differentiation, and tumor size. RESULTS: A total of 39,345 patients were identified; 76% were men and 34% were women (50% white, 12% African American, 21% Asian, 16% Hispanic, and 1% Native American). The median age at the time of diagnosis was 61 years for men and 67 years for women. Approximately 84% of patients had liver-limited disease and 16% had metastatic disease. Treatment information was available for patients diagnosed after 1998 (34,674 patients): 11% received liver-directed therapy, 11% underwent surgical resection, and 7% underwent liver transplantation. The HR for the OS of women versus men was 0.83 (95% confidence interval [95% CI], 0.77-0.88) for patients aged <55 years. The protective effect of sex on OS was found to be greatest in patients aged 18 to 44 years (HR, 0.75; 95% CI,), especially those with surgically resected tumors (HR, 0.68; 95% CI,) and those who were African American (HR, 0.85; 95% CI, 0.78-0.92 [P<.001]). There was no survival difference between sexes noted among Hispanics or patients aged >65 years. CONCLUSIONS: Sex appears to be associated with survival in patients with HCC. The role of androgens and estrogens in the development and progression of HCC warrants further investigation.

High-biologically effective dose palliative radiotherapy for a tumor thrombus might improve the long-term prognosis of hepatocellular carcinoma: a retrospective study

“…A retrospective study of 10,608 patients conducted by Norris Comprehensive Cancer Center demonstrated no gender-related difference in survival in Asian patients with HCC [20]. However, an autopsy study showed that a tumor thrombus was more common in female patients, and hormonal factors might play a role in neoplastic vascular invasion [21].…”

NAFLD as a Sexual Dimorphic Disease: Role of Gender and Reproductive Status in the Development and Progression of Nonalcoholic Fatty Liver Disease and Inherent Cardiovascular Risk

“…NAFLD-related HCC may also occur in non-cirrhotic livers, but this seems to be more likely in men [104]. The sexual dimorphism in HCC is also maintained regarding prognosis, with women showing better survival rates [102, 105]. However, menopause seems to attenuate these advantages [102, 105].…”

Regular hospital visits improve the prognosis of hepatocellular carcinoma after initial diagnosis: A single regional community hospital study

“…For the gender difference in HCC, it has been reported that survival in HCC of women is better compared to men; however, the reason had not been clearly elucidated (19,20). According to previous research that implied the cause of the sex difference in survival with HCC, women were more closely followed-up compared to men in the detection of early-stage HCC among high-risk patients (19).…”