Sarkar Monika, Dodge Jennifer L, Roberts John P, Terrault Norah, Yao Francis, Mehta Neil
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.
Ann Hepatol. 2016 Jul-Aug;15(4):545-9.
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.
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.
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.
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.
引言。男性患肝细胞癌（HCC）的风险高于女性。肝移植（LT）前甲胎蛋白（AFP）水平可有力预测LT后HCC复发。尽管HCC女性患者的AFP水平较高，但AFP水平的性别差异对LT后HCC复发的影响尚不清楚。
在这项基于器官共享联合网络（UNOS）的回顾性队列研究中，我们调查了2006年至2010年间MELD例外的LT受者中HCC复发的性别差异。协变量包括种族、疾病病因、合并症、登记及LT时的AFP、肿瘤负荷、局部区域治疗和供体风险指数。通过竞争风险回归评估HCC复发情况。
符合条件的队列（n = 5,002）包括3,872名男性和1,130名女性。258名男性（7%）和66名女性（6%）出现HCC复发。女性登记时的AFP中位数高于男性（14 vs. 11 ng/dL，p < 0.001）。虽然未检测到总体HCC复发的性别差异（风险比[HR] 0.9，95%置信区间[CI] 0.7 - 1.2，p = 0.38），但性别与AFP对复发风险存在强烈交互作用（p = 0.02）。LT时AFP在101 - 500 ng/dL的女性HCC复发率几乎是男性的三倍（HR 4.2，95% CI 2.2 - 8.2，p < 0.001）（HR 1.5，95% CI 1.1 - 2.1，p = 0.02）。
本研究揭示了LT后HCC复发存在新的性别差异，LT时AFP高的女性复发率几乎是男性的三倍。LT前AFP水平对女性和男性的预后影响似乎不同，一部分女性LT受者可能从LT后更密集的HCC监测中获益。
