Male sex is associated with higher mortality among patients with hepatocellular carcinoma

1. In patients with hepatocellular carcinoma, male sex was associated with significantly higher mortality compared to female sex, but the relationship was heterogeneous across liver disease etiologies.

Evidence Rating Level: 2 (Good)

Liver cancer is the sixth most common cancer, with HCC accounting for 75-90% of cases. There is an abundance of research that demonstrates males have a disproportionate incidence of HCC compared with females. However, there is limited data on the association of sex with HCC mortality. Some studies have found female sex to be independently associated with lower mortality, whereas other studies have found no association. This retrospective cohort study included patients aged 18 years or older with HCC between January 1, 2000, and December 31, 2023 across 17 centers from Japan, South Korea, Spain, Taiwan, and the US. Primary study outcomes were the incidence of overall, liver-related, and non-liver-related mortality. Of the initial cohort of 10 178 patients, 8594 (mean [SD] age, 63.3 [10.9] years; 27.7% female) were included. There were 5644 Asian [65.7%], 458 Black [5.3%], 615 Hispanic [7.2%], and 1784 White [20.8%]. In the full cohort, male sex was associated with increased overall mortality (adjusted hazard ratio [aHR], 1.14 [95% CI, 1.05-1.23]; P = .002). This association remained in subgroup analysis, with males having increased overall mortality in Asian (aHR, 1.22 [95% CI, 1.10-1.36]; P < .001), cirrhosis (aHR, 1.18 [95% CI, 1.08-1.29]; P < .001), and viral (aHR, 1.15 [95% CI, 1.05-1.26]; P = .004) subgroups. Additionally, males had significantly higher aHR in liver disease caused by alcohol (aHR, 1.90 [95% CI, 1.02-3.54]; P = .04), hepatitis B (aHR, 1.22 [95% CI, 1.01-1.47]; P = .04), and hepatitis C (aHR, 1.13 [95% CI, 1.02-1.26]; P = .03), but not in metabolic dysfunction–associated steatotic liver disease.

Click here to read this study in JAMA Network Open

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