Work

Prolonged survival in women with hepatocellular carcinoma: A French observational study

Year: 2024

Type: article

Abstract: • Hepatocellular carcinoma (HCC), the main type of primary liver cancer, affects men more than women, but little is known about gender differences, particularly in Europe. • Of the 694 French patients included in this study, only 18.7 % were women. • Women with HCC were older, more likely to have hepatitis C and more often had single tumors. • Although diagnosed at an older age, women had a better overall survival rate, suggesting that gender-specific factors may play a role in HCC outcomes. Background and Aim: Less than 25 % of hepatocellular carcinoma (HCC) occurs in women, in whom prognosis could be better. Due to the lack of date in Europe, this study aims to assess survival of patients with HCC according sex in a tertiary French liver center. Patients and Methods: Every patient diagnosed with a first diagnosis of HCC presented at our weekly multidisciplinary tumor board between 2013 and 2017 were included. Baseline characteristics of patients and tumors were compared according sex using the Mann-Whitney test for Continuous variables and the Fisher or Chi-square test for dichotomous variables. Survival analyses according sex were conducted using the Kaplan-Meier method, the log-rank test, Cox models and a propensity score. Results: 694 patients were included, of whom 130 (18.7 %) were women. Among them, 587 (86 %) had cirrhosis, mainly compensated (Child A 62.7 %), and related to alcohol (48.7 %), HCV (27.2 %), and/or metabolic-associated fatty liver disease (25.8 %). HCC was unifocal in 54 % of cases, with a mean main nodule size of 37 mm. Curative treatment was administered in 45.4 % of cases (percutaneous ablation 93 %). Compared to men, women diagnosed with HCC were older (73 vs. 65 years, p < 0.001), were more frequently HCV-infected (40 % vs. 24 %, p = 0.0003) and presented more often with a solitary HCC (63 % vs. 52 %, p = 0.020). After a median follow-up of 57 months, overall survival was significantly longer in women both in multivariate analysis (aHR 1.39 (CI95 %: 1.07-1.81) p=0.014) and using a propensity score (HR 1.51 (1.13-2.02, p=0.005)). Conclusion: Despite being diagnosed at an older age, women with HCC exhibit significant better overall survival.

Source: Clinics and Research in Hepatology and Gastroenterology

DOI: 10.1016/j.clinre.2024.102498