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Differential prognoses among male and female patients with hepatocellular carcinoma
Cheng-Yen Liao1,2, Chun-Yang Lee1, Cheng-Yi Wei1,2
1Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Insights
Sex does not independently predict hepatocellular carcinoma (HCC) outcomes. While males presented younger with greater tumor burden, female sex was linked to lower mortality in younger patients, but not older ones.
Area of Science:
- Hepatology
- Oncology
- Clinical Research
Background:
- Hepatocellular carcinoma (HCC) incidence is higher in males.
- The influence of sex on HCC prognosis is not well understood.
- This study investigates sex-based differences in HCC clinical presentation and outcomes.
Purpose of the Study:
- To compare clinical manifestations between male and female HCC patients.
- To evaluate the impact of sex on HCC prognosis.
- To identify sex-specific prognostic factors in HCC.
Main Methods:
- Retrospective analysis of 5337 HCC patients (2007-2020).
- Prognostic factors identified using Cox proportional hazards model.
- Subgroup analyses based on age and treatment modalities.
Main Results:
- Male patients were younger at diagnosis and had higher tumor burden but better hepatic reserves.
- Fewer males received curative therapies compared to females (49.0% vs 57.0%).
- Overall 5-year survival was lower for males (37.1%) than females (41.9%), but male sex was not an independent predictor of poor survival.
Conclusions:
- Sex is not an independent predictor of HCC outcomes.
- Female sex was associated with lower mortality in younger HCC patients (≤50 years).
- Prognostic impact of sex on HCC is minimal in older patients (>50 years).
Background:
The incidence of hepatocellular carcinoma (HCC) is significantly higher in men than women. Nonetheless, the impact of sex disparities on HCC outcomes remains unclear. We aimed to compare the clinical manifestations and prognoses between male and female patients with HCC.
Methods:
This retrospective study enrolled 5337 consecutive patients (3976 men, 1361 women) who were diagnosed with HCC from 2007 to 2020. The prognostic factors were identified by the Cox proportional hazards model.
Results:
Male patients were younger upon HCC diagnosis (median age 64 vs 69 years; p < 0.001) with more favorable hepatic functional reserves (39.0% vs 35.1% albumin-bilirubin grade 1; p = 0.025) but had greater tumor burdens than the female patients. Furthermore, fewer male patients underwent curative therapies for HCC compared with the female patients (49.0% vs 57.0%; p < 0.001). After a median follow-up of 20.1 months (interquartile range, 5.8-47.3 months), 3133 patients died. The cumulative 5-year overall survival rates were 37.1% and 41.9% for male and female patients, respectively (p < 0.001). From the multivariate analysis, male sex was not an independent factor predictive of poor overall survival in all patients and in the subgroup analysis stratified by treatment modalities. When stratified by age, the female sex was an independent factor associated with lower mortality in younger (≤50 years) patients but not in older patients with HCC.
Conclusion:
Sex was not an independent predictor of the outcome of patients with HCC, especially for those aged more than 50 years.
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