Digestive Diseases and Sciences

, Volume 58, Issue 10, pp 2817–2825

United States Women Receive More Curative Treatment for Hepatocellular Carcinoma Than Men

  • Stephanie Cauble
  • Ali Abbas
  • Luis Balart
  • Lydia Bazzano
  • Sabeen Medvedev
  • Nathan Shores
Original Article

Abstract

Background

Previous database studies have found gender disparities favoring men in rates of liver transplantation, which resolve in cohorts examining only patients with hepatocellular carcinoma (HCC).

Aims

Our study aims to use two large, multicenter United States (US) databases to assess for gender disparity in HCC treatment regardless of transplant listing status.

Methods

We performed a retrospective database analysis of inpatient admission data from the University Health Consortium (UHC) and the Nationwide Inpatient Sample (NIS), over a 9- and 10-year period, respectively. Adults with a primary discharge diagnosis of HCC, identified using the International Classification of Diseases 9th Edition (ICD-9) code, were included. Series of univariate and multivariate analyses were performed to examine gender disparities in metastasis, liver decompensation, treatment type, and inpatient mortality after controlling for other possible predictors.

Results

We included 26,054 discharges from the NIS database and 25,671 patients from the UHC database in the analysis. Women with HCC appear to present less often with decompensated liver disease (OR = 0.79, p < 0.001). Furthermore they are more likely to receive invasive HCC treatment, with significantly higher rates of resection across race and diagnoses (OR = 1.34 and 1.44, p < 0.001). Univariate analyses show that US women have lower unadjusted rates of transplant; however, the disparity resolves after controlling for other clinical and demographic factors.

Conclusions

US women more often receive invasive treatment for HCC (especially resection) than US men with no observed disparity in transplantation rates when adjusted for pre-treatment variables.

Keywords

Resection Hepatocellular carcinoma Gender Disparities 

References

  1. 1.
    Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127:2893–2917.PubMedCrossRefGoogle Scholar
  2. 2.
    El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365:1118–1127.PubMedCrossRefGoogle Scholar
  3. 3.
    Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: Incidence and risk factors. Gastroenterology. 2004;127:S35–S50.PubMedCrossRefGoogle Scholar
  4. 4.
    de Lope CR, Tremosini S, Forner A, Reig M, Bruix J. Management of HCC. J Hepatol. 2012;56:S75–S87.PubMedCrossRefGoogle Scholar
  5. 5.
    Bruix J, Sherman M. Practice guidelines committee AeAftSoLD: Management of hepatocellular carcinoma. Hepatology. 2005;42:1208–1236.PubMedCrossRefGoogle Scholar
  6. 6.
    Bruix J, Sherman M. Diseases AAftSoL: Management of hepatocellular carcinoma: An update. Hepatology. 2011;53:1020–1022.PubMedCrossRefGoogle Scholar
  7. 7.
    Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: The BCLC update and future prospects. Semin Liver Dis. 2010;30:61–74.PubMedCrossRefGoogle Scholar
  8. 8.
    Moylan CA, Brady CW, Johnson JL, Smith AD, Tuttle-Newhall JE, Muir AJ. Disparities in liver transplantation before and after introduction of the MELD score. JAMA. 2008;300:2371–2378.PubMedCrossRefGoogle Scholar
  9. 9.
    University Health Consortium, (HCUP) HCaUP: National inpatient sample. http://www.uhc.edu. Accessed 5 September 2011.
  10. 10.
    Healthcare Cost and Utilization Project (HCUP) HCaUP. National Inpatient Sample. http://www.hcup-us.ahrq.gov/nisoverview.jsp. Accessed 4 September 2011.
  11. 11.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40:373–383.PubMedCrossRefGoogle Scholar
  12. 12.
    Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–619.PubMedCrossRefGoogle Scholar
  13. 13.
    Shavers VL, Harlan LC, Stevens JL. Racial/ethnic variation in clinical presentation, treatment, and survival among breast cancer patients under age 35. Cancer. 2003;97:134–147.PubMedCrossRefGoogle Scholar
  14. 14.
    Simons JP, Ng SC, Hill JS, Shah SA, Zhou Z, Tseng JF. In-hospital mortality from liver resection for hepatocellular carcinoma: A simple risk score. Cancer. 2010;116:1733–1738.PubMedCrossRefGoogle Scholar
  15. 15.
    Singal AG, Chan V, Getachew Y, Guerrero R, Reisch JS, Cuthbert JA. Predictors of liver transplant eligibility for patients with hepatocellular carcinoma in a safety net hospital. Dig Dis Sci. 2012;57:580–586.PubMedCrossRefGoogle Scholar
  16. 16.
    Dohmen K, Shigematsu H, Irie K, Ishibashi H. Longer survival in female than male with hepatocellular carcinoma. J Gastroenterol Hepatol. 2003;18:267–272.PubMedCrossRefGoogle Scholar
  17. 17.
    Kalra M, Mayes J, Assefa S, Kaul AK, Kaul R. Role of sex steroid receptors in pathobiology of hepatocellular carcinoma. World J Gastroenterol. 2008;14:5945–5961.PubMedCrossRefGoogle Scholar
  18. 18.
    Mindikoglu AL, Regev A, Seliger SL, Magder LS. Gender disparity in liver transplant waiting-list mortality: The importance of kidney function. Liver Transpl. 2010;16:1147–1157.PubMedCrossRefGoogle Scholar
  19. 19.
    Cholongitas E, Marelli L, Kerry A, et al. Female liver transplant recipients with the same GFR as male recipients have lower MELD scores—a systematic bias. Am J Transplant. 2007;7:685–692.PubMedCrossRefGoogle Scholar
  20. 20.
    Myers RP, Shaheen AA, Aspinall AI, Quinn RR, Burak KW. Gender, renal function, and outcomes on the liver transplant waiting list: Assessment of revised MELD including estimated glomerular filtration rate. J Hepatol. 2011;54:462–470.PubMedCrossRefGoogle Scholar
  21. 21.
    Farinati F, Sergio A, Giacomin A, et al. Is female sex a significant favorable prognostic factor in hepatocellular carcinoma? Eur J Gastroenterol Hepatol. 2009;21:1212–1218.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Stephanie Cauble
    • 1
    • 5
  • Ali Abbas
    • 1
    • 2
  • Luis Balart
    • 1
  • Lydia Bazzano
    • 3
  • Sabeen Medvedev
    • 4
  • Nathan Shores
    • 1
  1. 1.Department of Medicine, Section of Gastroenterology and HepatologyTulane University Health Sciences CenterNew OrleansUSA
  2. 2.Department of MedicineUniversity of FloridaGainesvilleUSA
  3. 3.Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansUSA
  4. 4.Department of MedicineGeorge Washington University Medical CenterWashington, DCUSA
  5. 5.Baton RougeUSA

Personalised recommendations