title: Is female sex a significant favorable prognostic factor in hepatocellular carcinoma?
abstract: OBJECTIVE
  As sex favorably modulates the natural history of chronic liver diseases and the risk for neoplastic evolution, our study aimed to ascertain whether female hepatocellular carcinoma (HCC) patients are also characterized by better prognosis.
  
  
  METHODS
  The ITA.LI.CA (Italian Liver Cancer) database was used, including 1834 HCC patients (482 females, 1352 males) that were consecutively diagnosed. The following variables were considered: age, etiology, modality of diagnosis, earlier interferon treatment, bilirubin, alpha-fetoprotein levels, constitutional syndrome, portal thrombosis, metastasis, number and size of nodules, grading, Child-Pugh class, tumor-nodes-metastases and Cancer of the Liver Italian Program staging, and treatment.
  
  
  RESULTS
  Female HCC patients were characterized by older age (P=0.0001), higher prevalence of HCV infection (P=0.0001), diagnosis more frequently by surveillance (P=0.003), higher alpha-fetoprotein levels (P=0.0055), lower prevalence of constitutional syndrome (P=0.03), portal thrombosis (P=0.04), and metastasis (P=0.0001). HCC in females was more frequently unifocal (P=0.0001), smaller (P=0.001), well differentiated (P=0.001), and of lower Cancer of the Liver Italian Program and tumor-nodes-metastases stage (P=0.0001 and 0.0001). However, females underwent curative treatments (transplantation, resection, percutaneous ablation) in the same percentage of cases as males. Finally, females had a significantly longer survival (median 29 [95% confidence interval (CI): 24-33] vs. 24 (22-25) months, P=0.0001). The difference was sharper [median 36 (CI: 31-41] vs. 17 (CI: 15-19)] when females undergoing surveillance were compared with males diagnosed incidentally or for symptoms. The Cox model also identified sex as an independent predictor of survival. When only patients undergoing surveillance were considered, no significant difference was observed.
  
  
  CONCLUSIONS
  HCC in females has better prognosis, but this is possibly more because of higher compliance with surveillance than to real biological differences.
authors.affiliation: Dipartimento di Scienze Chirurgiche e Gastroenterologiche, Università di Genova iUnità di Gastroenterologia, Ospedale Belcolle, Viterbo, Italy. fabio.farinati@unipd.it
authors.forename: Fabio
authors.initials: F
authors.lastname: Farinati
authors.forename: Adriana
authors.initials: A
authors.lastname: Sergio
authors.forename: Anna
authors.initials: A
authors.lastname: Giacomin
authors.forename: Maria Anna
authors.initials: MA
authors.lastname: Di Nolfo
authors.forename: Paolo
authors.initials: P
authors.lastname: Del Poggio
authors.forename: Luisa
authors.initials: L
authors.lastname: Benvegnù
authors.forename: Gianludovico
authors.initials: G
authors.lastname: Rapaccini
authors.forename: Marco
authors.initials: M
authors.lastname: Zoli
authors.forename: Franco
authors.initials: F
authors.lastname: Borzio
authors.forename: Edoardo G
authors.initials: EG
authors.lastname: Giannini
authors.forename: Eugenio
authors.initials: E
authors.lastname: Caturelli
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D004812:Epidemiologic Methods; D005260:Female; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011379:Prognosis; D012737:Sex Factors