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Abstract Details
Gender Matters: Characteristics of Hepatocellular Carcinoma in Women From a Large, Multicenter Study in the United States
Am J Gastroenterol. 2020 May 22. doi: 10.14309/ajg.0000000000000643. Online ahead of print.
Meaghan Phipps1, Alexandra Livanos2, Averill Guo3, Sydney Pomenti3, Jonathan Yeh4, Lara Dakhoul5, Heather Burney6, Carla Kettler6, Hao Liu6, Ethan Miller7, Samer Gawrieh5, Andrew deLemos8, Andrew Scanga9, Naga Chalasani5, Julia Wattacheril4
Author information
1Department of Medicine, Division of Digestive and Liver Diseases, Columbia University Irving Medical Center, New York, New York, USA.
2Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
3Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA.
4Department of Surgery, Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York, New York, USA.
5Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
6Department of Biostatistics, Indiana University, Indianapolis, Indiana, USA.
7Department of Gastroenterology, Hepatology, and Nutrition, MD Anderson Cancer Center, Houston, Texas, USA.
8Department of Medicine, Division of Hepatology, Atrium Health, Charlotte, North Carolina, USA.
9Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Abstract
Introduction: Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide, affecting men to women at a ratio of about 4:1. Risk factors, characteristics, and outcomes for HCC in women in the United States remain poorly understood; therefore, we aim to explore gender differences further.
Methods: Patients diagnosed with HCC between January 2000 and June 2014 at 5 large centers were identified. Clinical information, tumor characteristics, and survival data were extracted manually. The presence of underlying cirrhosis was assessed based on published criteria.
Results: Of 5,327 patients with HCC in our cohort, 1,203 (22.6%) were women. There were important differences in the underlying etiology of liver disease between the 2 genders (P < 0.0001): women had a significantly higher frequency of nonalcoholic fatty liver disease (23% vs 12%) and lower frequency of alcoholic liver disease (5% vs 15%). The proportion of noncirrhotic HCC was significantly higher among women (17% vs 10%, P < 0.0001). Women had less-advanced HCC at presentation by tumor, node, metastasis staging (P < 0.0001) and a higher proportion within Milan criteria (39% vs 35%, P = 0.002). Women had a greater overall survival (2.5 ± 2.9 years vs 2.2 ± 2.7 years, P = 0.0031).
Discussion: The frequency of underlying nonalcoholic fatty liver disease and noncirrhotic HCC were significantly higher in women than men in this large cohort. Women presented with less-advanced HCC and had a greater overall survival. Further investigation is warranted to explore potential mechanisms and implications for these gender differences, especially with noncirrhotic HCC (see Visual Abstract, Supplementary Digital Content 1, http://links.lww.com/AJG/B535).