Sex differences in disease presentation, treatment and clinical outcomes of patients with hepatocellular carcinoma: a single-centre cohort study.
Sex differences in disease presentation, treatment and clinical outcomes of patients with hepatocellular carcinoma: a single-centre cohort study.
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DOI：
10.1136/bmjgast-2016-000107
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发表时间：
2016
影响因子：
3.1
通讯作者：
Nguyen MH
中科院分区：
文献类型：
--
作者：
Ladenheim MR;Kim NG;Nguyen P;Le A;Stefanick ML;Garcia G;Nguyen MH
虽然肝细胞癌（HCC）风险的性别差异是众所周知的，但在HCC发生后的临床表现和生存结果中是否也存在性别差异尚不清楚。我们对1998-2015年在美国某医疗中心就诊的1886例HCC患者进行了回顾性队列研究。数据通过图表回顾获得，生存数据也通过国家死亡指数检索获得。该队列包括1449名男性和437名女性患者。诊断时，男性明显年轻于女性（59.9±10.7 vs 64.0±11.6,p<0.0001）。男性吸烟（57.7%比31.0%,p<0.001）和饮酒（63.2%比35.1%,p<0.001）的比例明显更高。与症状性或偶发性筛查相比，女性更有可能通过常规筛查被诊断出来（65.5% vs 58.2%, p=0.03），更不可能出现直径为50厘米的肿瘤（30.2% vs 39.8%, p=0.001）。手术和非手术治疗的使用在两性中相似。自诊断时起，男性和女性的中位生存期无显著差异（中位30.7（范围= 24.5-41.3）vs 33.1（范围= 27.4-37.3）个月，p=0.84）。在多变量分析中，提高生存率的重要预测因素包括年龄更小、手术或非手术治疗（与支持治疗相比）、筛查诊断、符合米兰标准的肿瘤和终末期肝病模型评分较低，但不包括女性（调整后HR=1.01, CI 0.82至1.24,p=0.94）。尽管男性发生HCC的风险要高得多，但除了年龄较大和女性诊断时肿瘤负担较低外，在疾病表现或生存方面没有显著的性别差异。女性性别并不是生存的独立预测因素。
Although sex differences in hepatocellular carcinoma (HCC) risk are well known, it is unclear whether sex differences also exist in clinical presentation and survival outcomes once HCC develops. We performed a retrospective cohort study of 1886 HCC patients seen in a US medical centre in 1998–2015. Data were obtained by chart review with survival data also by National Death Index search. The cohort consisted of 1449 male and 437 female patients. At diagnosis, men were significantly younger than women (59.9±10.7 vs 64.0±11.6, p<0.0001). Men had significantly higher rates of tobacco (57.7% vs 31.0%, p<0.001) and alcohol use (63.2% vs 35.1%, p<0.001). Women were more likely to be diagnosed by routine screening versus symptomatically or incidentally (65.5% vs 58.2%, p=0.03) and less likely to present with tumours >5 cm (30.2% vs 39.8%, p=0.001). Surgical and non-surgical treatment utilisation was similar for both sexes. Men and women had no significant difference in median survival from the time of diagnosis (median 30.7 (range=24.5–41.3) vs 33.1 (range=27.4–37.3) months, p=0.84). On multivariate analysis, significant predictors for improved survival included younger age, surgical or non-surgical treatment (vs supportive care), diagnosis by screening, tumour within Milan criteria and lower Model for End-Stage Liver Disease score, but not female sex (adjusted HR=1.01, CI 0.82 to 1.24, p=0.94). Although men have much higher risk for HCC development, there were no significant sex differences in disease presentation or survival except for older age and lower tumour burden at diagnosis in women. Female sex was not an independent predictor for survival.