Prognosis of patients with hepatocellular carcinoma: Sex does not matter

Abstract

Although sex-related disparities in hepatocellular carcinoma (HCC) incidence have been well-reported, whether any such disparities exist in HCC prognosis remains controversial. We aim to characterize sex-related differences in HCC presentation and prognosis. Consecutive patients who were newly diagnosed with HCC between 2011 and 2020 at our institution were enrolled in this retrospective study. Of the 3977 identified patients diagnosed with HCC between January 2011 and December 2020, 72.2% were men (n = 2871) and 27.8% were women (n = 1106). The age at HCC diagnosis was higher (p < .001), the proportion positive for hepatitis B surface antigen was lower (p < .001), the proportion positive for anti-hepatitis C virus antibody was higher (p < .001), the proportion of alcoholics was lower (p < .001), the proportion with early stage tumor (i.e., Barcelona Clinic Liver Cancer [BCLC] stages 0 and A) was higher (p < .001), the proportion with alpha-fetoprotein (AFP) >20 ng/mL was higher (p = .02), the proportion with cirrhosis was higher (p < .001), the proportion in receipt of liver resection was lower, and the proportion in receipt of ablation was higher (p < .001) among women than among men. Multivariate analysis showed that an age of >65 years (hazard ratio [HR] = 1.162; 95% confidence interval [CI] = 1.051–1.285; p = .003), BCLC stages B–D (HR = 2.660; 95% CI = 2.372–2.983; p < .001), AFP >20 ng/mL (HR = 1.776; 95% CI = 1.599–1.971; p < .001), and non-curative treatment (HR = 3.248; 95% CI = 2.910–3.624; p < .001) were associated with mortality, whereas sex was not. Sex was not an independent predictor of mortality of patients with HCC.