Sex disparities in presentation and prognosis of 1110 patients with hepatocellular carcinoma

Abstract

Summary Background Although sex disparities in hepatocellular carcinoma (HCC) incidence have been well described, there are limited data examining sex disparities in HCC prognosis. Aim To characterise sex differences in HCC presentation and prognosis. Methods We performed a retrospective study of consecutive patients (n = 1110, 23.5% women) diagnosed with HCC between 2008 and 2017 at two US health systems. We used Cox proportional hazard and multivariable logistic regression models to identify factors associated with overall survival, early tumour detection and response to HCC treatment (per the modified Response Evaluation Criteria in Solid Tumors [mRECIST] criteria). Results Women were older at HCC diagnosis (mean 62.5 vs 59.2 years, P < 0.001) and had a higher proportion of early‐stage tumours (53.1% vs 43.7% Barcelona Clinic Liver Cancer [BCLC] stage 0/A, P = 0.04), but similar liver function compared to men (49.2% vs 47.1% Child Pugh A, P = 0.27). In univariable analysis, women had significantly better overall survival than men (median 17.1 vs 12.0 months, P = 0.02). When stratified by age, younger (<65 years) women had better overall survival than men (18.3 vs 11.2 months, P = 0.02); however, older (≥65 years) women and men had similar overall survival (15.5 vs 15.7 months, P = 0.45). In multivariable analysis, female sex was independently associated with lower mortality after adjusting for age, race/ethnicity, alpha‐fetoprotein, BCLC stage, Albumin‐Bilirubin grade and Child Pugh score (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.68‐0.98). In secondary analyses, female sex was independently associated with early tumour detection (odds ratio [OR] 1.46, 95% CI 1.05‐2.02) and response to first HCC treatment (OR 1.72, 95% CI 1.18‐2.53) after adjusting for the same covariates. Conclusion In a large cohort of patients with HCC, women had significantly better prognosis than men.

Letter: sex disparity in prognosis of patients with hepatocellular carcinoma after resection

“…2 The influence of sex disparity among patients with HCC on prognosis has been controversial. Some studies [2][3][4][5][6] are consistent with the findings of Rich et al, 1 while others are not. [7][8][9] More studies on the influence of sex disparity in HCC patients are required.…”

Letter: female patients with hepatocellular carcinoma may have better prognosis than male patients

“…Six reported that female patients had significantly higher OS than male patients. [1][2][3][8][9][10] However, the other four studies found similar OS. [4][5][6][7] We calculated pooled HRs and 95% CIs based on the six studies reporting these values.…”

“…[4][5][6][7] We calculated pooled HRs and 95% CIs based on the six studies reporting these values. [1][2][3][4]6,7 The pooled HR (95% CI) was 0.90 (0.81-1.01; P = 0.07).…”

“…Ten studies involving 51 506 patients with HCC from seven countries or regions were included in the analysis (Table 1). [1][2][3][4][5][6][7][8][9][10] Men were disproportionately affected compared to women 2.2-to 6.7-fold. All studies reported that female patients were older at diagnosis.…”

Sex-Biased Molecular Signature for Overall Survival of Liver Cancer Patients

“…Although sex-biased differences in HCC development risk are well recognized ( Setiawan et al ., 2016 ; Wu et al ., 2018 ; Yu et al ., 2019 ; Rich et al ., 2020 ), the prognosis between sexes remains unclear. Sex hormones are expected to play an important role in the sex disparity of malignancy.…”