在疾病表现，治疗和肝癌患者的临床结果的性别差异：一个

StephenW

BMJ Open Gastro 2016; 3:e000107 doi:10.1136/bmjgast-2016-000107
Sex differences in disease presentation, treatment and clinical outcomes of patients with hepatocellular carcinoma: a single-centre cohort study
Maya R Ladenheim12, Nathan G Kim3, Pauline Nguyen1, An Le1, Marcia L Stefanick4, Gabriel Garcia1, Mindie H Nguyen1
Author Affiliations
1Department of Medicine, Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California, USA
2Department of Biology, Washington University, St. Louis, Missouri, USA
3Stanford University School of Medicine, Stanford, California, USA
4Department of Medicine, Stanford Center for Prevention Research, Stanford University School of Medicine, Stanford, California, USA
Received:
12 June 2016
Accepted:
05 July 2016
Published Online:
25 July 2016


Abstract
Background

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.
Methods

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.
Results

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).
Conclusions

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.
Keywords: HEPATOCELLULAR CARCINOMA, SURVEILLANCE, SCREENING

StephenW

BMJ打开胃2016年; 3：e000107 DOI：10.1136 / bmjgast-2016-000107
在疾病表现，治疗和肝癌患者的临床结果的性别差异：一个单中心队列研究
玛雅 - [R Ladenheim12，弥敦道摹Kim3，宝莲Nguyen1，一个LE1，玛西娅大号Stefanick4，加布里埃尔Garcia1，Mindie ^ h Nguyen1
作者机构
医学教研室，消化内科和肝病，斯坦福大学医学中心，帕洛阿尔托，加利福尼亚州，美国的科
生物学教研室，华盛顿大学，圣路易斯，密苏里州，美国
医药，斯坦福大学，美国加利福尼亚州的3Stanford学院
医药，斯坦福中心预防研究，医学斯坦福大学医学院，斯坦福大学，美国加利福尼亚州的4Department
收稿日期：
2016年6月12日
公认：
2016年7月5日
在线发布时间：
2016年7月25日


抽象
背景

虽然在肝细胞癌（HCC）风险的性别差异是众所周知的，目前还不清楚的性别差异是否还在临床表现存在和生存结果一旦HCC的发展。
方法

我们进行的1886年，在1998至2015年美国的医疗中心看到肝癌患者的回顾性队列研究。数据通过图审查与生存数据也被国家死亡索引搜索获得。
结果

该队列包括1449男性和437女性患者。在诊断时，男性比女性（59.9±10.7 VS 64.0±11.6，P <0.0001）显著年轻。男人有烟草显著率较高（57.7％比31.0％，P <0.001）和酒精的使用（63.2％VS 35.1％，P <0.001）。女性更容易通过常规的筛查诊断对症对比或附带（65.5％比58.2％，P = 0.03），不太可能提出与肿瘤> 5厘米（30.2％比39.8％，P = 0.001）。手术和非手术治疗利用率为两性相似。男人和女人必须从诊断的时间，中位生存期无显著差异（中位数30.7（范围= 24.5-41.3）与33.1（范围= 27.4-37.3）个月，P = 0.84）。多变量分析显示，以提高生存显著预测因素包括：年龄小，手术或非手术治疗（VS支持治疗），诊断筛查，肿瘤米兰标准内，并终末期肝病评分较低型号，而不是女性（调整HR = 1.01，CI 0.82 1.24，p = 0.94）。
结论

虽然男人对肝癌的发展面临更大的危险，有疾病演示或存活没有显著的性别差异，除非在确诊的女性年龄和降低肿瘤负荷。女性性不是生存的独立预测因子。
关键词：肝细胞癌，监控，筛选