Longer survival in female than male with hepatocellular carcinoma

AIM: There is a limited amount of data regarding the gender difference in the survival in cases of hepatocellular carcinoma (HCC). The aim of the present study was to investigate the difference in the survival between males and females with HCC and the possible factors affecting the gender difference of survival in HCC. METHODS: Analyses were performed based on 704 consecutive patients with HCC observed for 12 years between January 1989 and December 2000 at the Internal Medicine Department, Saga Prefectural Hospital Koseikan, who were retrospectively enrolled in the study. The 1-, 3-, 5- and 7-year survivals and various factors at the detection of HCC were compared between 487 male and 217 female patients with HCC using the Kaplan-Meier method, Mantel-Cox test, chi squared test and Fisher's exact analysis. RESULTS: There was a significant difference in survival between male and female patients with a 1-, 3-, 5- and 7-year survival estimate of 67.7, 40.6, 23.8 and 8.7%versus 73.5, 50.3, 26.3 and 15.4%, respectively (P-value: 0.0167). Of the clinical variables examined, the significant factors related to gender difference were found to be age, tumor size, the number of tumors, the presence of portal thrombosis and the type of follow-up. Of the patients with HCC lesions measuring 3 cm or less in the greatest dimension or those with solitary HCCs, however, there was no significant difference in survival between both sexes. The patients were divided into three categories: closely followed-up group (regular periodic follow-up with monthly alpha-fetoprotein measurements plus ultrasonography at least every 4 months); a non-closely followed-up group; and an incidental group (incidentally discovered due to related symptoms). The detection rates of HCC through the closely followed-up, non-closely followed-up and incidental groups were 19.3%, 46.2% and 34.5% in men and 28.1%, 46.5% and 25.4% in women, respectively, which reached a significant difference between both sexes (P-value: 0.0097). CONCLUSION: The survival of female cases of HCC was longer than that of male cases. Disparities in the type of follow-up for women in comparison to men exist and may contribute to gender disparities in survival. Women with a high risk for HCC tended to be better cared for during the follow-up. To reduce gender disparities in survival, efforts should be directed at the earlier identification of HCC.