HCC Recurrence More Common in Men After Curative Surgery

After curative hepatectomy for hepatocellular carcinoma (HCC), men were more likely than women to experience a cancer recurrence, resulting in worse long-term survival, a retrospective study found.

Among over 1,000 HCC patients who underwent hepatectomy at a single center in China, adjusted multivariate regression and propensity score-matching analyses found men to have a 48-59% greater recurrence risk (HR 1.48, 95% CI 1.08-2.02, P=0.014, and HR 1.59, 95% CI 1.09-2.31, P=0.015, respectively), reported Tao Peng, MD, of Guangxi Medical University in Nanning, China, and colleagues.

This increased risk in men was driven primarily by HCC recurrences occurring in the first 2 years following surgery (OR 1.86, 95% CI 1.22-2.94, P=0.006), the authors wrote in Annals of Hepatology.

On propensity score matching, incidence of recurrence following hepatectomy was greater in men versus women, respectively, at all time points (P=0.015):

• 1 year: 18.6% vs 15.0%
• 3 years: 38.2% vs 25.7%
• 5 years: 49.9% vs 35.8%

As was all-cause mortality (P=0.035):

• 1 year: 4.3% vs 2.6%
• 3 years: 20.7% vs 13.4%
• 5 years: 29.3% vs 18.1%

“Although many studies have studied the survival disparity associated with gender in HCC, few studies have taken the balance of parameters into consideration,” wrote Peng and coauthors.

HCC is the third leading cause of cancer-related deaths, often developing in patients with heavy alcohol consumption or hepatitis B or C infections, the group noted. “Curative” hepatectomy can prolong survival but is reserved for those without cirrhosis or with mild cirrhosis and preserved liver function, and still, more than two-thirds experience a recurrence within 5 years of surgery.

For their study, the researchers examined data on 1,087 consecutive HCC patients from Guangxi Medical University who from 2012 to 2018 underwent a first curative hepatectomy. Follow-up occurred every 3 months during the first year, and then every 6 months thereafter.

Overall, 84% of the patients were men, 45-48% had cirrhosis, and 75-84% had hepatitis B. For tumor characteristics, about three-fourths of patients had Barcelona Clinic Liver Cancer stage A tumors, 10-11% had multiple nodules, and 8% had macrovascular invasion.

Men were more likely to smoke (41% vs 0.6%) and drink alcohol than women (38% vs 1%), and more had a BMI ≥25 (26% vs 17%). Women, meanwhile, were more likely to be 50 years or older (61% vs 47%), have hypertension (15% vs 10%), and have alpha fetoprotein (AFP) levels ≥400 ng/mL (41% vs 32%).

Multivariate regression analysis adjusted for age, cirrhosis, diabetes, AFP, Child-Pugh grade, and microvascular and macrovascular invasion, among others.

Subgroup analyses found that the higher recurrence risk seen in men was not statistically dependent on any of the factors the researchers analyzed, including BMI, diabetes, hypertension, Child-Pugh grade, history of hepatitis, tumor node, or tumor diameter, among others.

The authors acknowledged several limitations to the data. The cohort was mainly composed of patients with hepatitis B-related HCC. Additional unmeasured propensity score parameters could have introduced bias.