Sex disparity in hepatocellular carcinoma recurrence after curative liver resection: a multicenter comprehensive analysis.

Background and aims: The impact of sex disparity on the patterns of recurrence after curative resection of hepatocellular carcinoma (HCC) remains controversial. The aim of this study was to comprehensively investigate the influence of sex differences in HCC recurrence following curative hepatectomy.

Methods: Patients who underwent curative-intent resection for HCC between July 2015 and June 2020 were identified from a multicenter database and analyzed retrospectively. Tumor recurrence was evaluated using Cox regression and Kaplan-Meier methods. Hazard curves representing the changes in risk of recurrence over time were evaluated. Propensity score matching and a competing risk model were used for sensitivity analysis.

Results: Of 1570 patients, 1334 (85.0%) were men, and 236 (15.0%) were women. Female patients showed significantly lower risk for HCC recurrence than males in the multivariate Cox regression analysis (hazard rate: 0.75, 95% confidence interval: 0.61-0.93, P  = 0.008). Landmark analysis showed that sex was an independent risk factor for late recurrence, but not for early recurrence. The hazard function curve for female patients was relatively flat [peak hazard rates (pHR): 0.0234], while males recurred with a peak at 3.0 months (pHR: 0.0302). A lower risk of HCC recurrence was also found in females in the sensitive analysis.

Conclusion: Male patients had a higher risk of HCC recurrence than females after surgery, and recurrence hazard rates for different sexes varied substantially with respect to both time and peak rates.