title: Increased hepatocellular carcinoma recurrence in women compared to men with high alpha fetoprotein at liver transplant.
abstract: Introduction. Men have higher risk for hepatocellular carcinoma (HCC) than women. Pre liver transplant (LT) alpha fetoprotein (AFP) levels strongly predict post LT HCC recurrence. Though women with HCC have higher AFP, the contribution of AFP level by gender to post LT HCC recurrence is unknown.
  
  
  METHODS
  In this UNOSbased, retrospective cohort study we investigate sex differences in HCC recurrence among LT recipients with MELD exception between 2006-2010. Covariates include race, disease etiology, co-morbidities, AFP at listing and LT, tumor burden, loco-regional therapy, and donor risk index. HCC recurrence was assessed by competing risks regression.
  
  
  RESULTS
  Of the eligible cohort (n = 5,002) included 3,872 men and 1,130 women. HCC recurred in 258 men (7%) and 66 women (6%). Median listing AFP was higher in women than men (14 vs. 11 ng/dL, p < 0.001). While no sex difference in overall HCC recurrence was detected (HR 0.9, 95% CI 0.7-1.2, p = 0.38), there was a strong interaction between gender and AFP on recurrence risk (p = 0.02). HCC recurrence was nearly three times higher in women (HR 4.2, 95% CI 2.2-8.2, p < 0.001) than men (HR 1.5, 95% CI 1.1-2.1, p = 0.02) with AFP at LT between 101-500 ng/dL.
  
  
  CONCLUSIONS
  This study reveals novel sex differences in post LT HCC recurrence, which was nearly three times higher in women than men with high AFP at LT. Pre-LT AFP levels appear to carry a different prognosis in women than men, and a subset of female LT recipients may benefit from more intensive HCC surveillance after LT.
authors.affiliation: Division of Gastroenterology and Hepatology and University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: Monika
authors.initials: M
authors.lastname: Sarkar
authors.affiliation: Division of Transplant Surgery. University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodge
authors.affiliation: Division of Transplant Surgery. University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
authors.affiliation: Division of Gastroenterology and Hepatology and University of California San Francisco (UCSF), San Francisco, California, United States; Division of Transplant Surgery. University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: Norah
authors.initials: N
authors.lastname: Terrault
authors.affiliation: Division of Gastroenterology and Hepatology and University of California San Francisco (UCSF), San Francisco, California, United States; Division of Transplant Surgery. University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: Francis
authors.initials: F
authors.lastname: Yao
authors.affiliation: Division of Gastroenterology and Hepatology and University of California San Francisco (UCSF), San Francisco, California, United States.
authors.forename: Neil
authors.initials: N
authors.lastname: Mehta
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000378:metabolism; D011379:Prognosis; D012189:Retrospective Studies; D012737:Sex Factors; D014019:Tissue Donors; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D000509:alpha-Fetoproteins