ASCO2013：流行病学之性别对肝癌患者生存的关系

这是来对SEER数据库的分析结果，包括了38,250名肝癌患者，其中76%为男性，男性和女性肝癌诊断时的中位年龄分别为61岁和68岁。总体生存率方面：55岁以下的人群，女性相对于男性的相对危险度为0.83（95%CI 0.78-0.89）；55岁及以上，相对危险度为0.95（95%CI 0.92-0.98）；65岁及以上，相对危险度为0.98 (95%CI 0.94-1.01)。看起来，性别对于肝癌总体生存的保护作用只存在于围绝经期或绝经前期的女性。这也好理解，55岁之前才有足量的雌激素保护她们。

摘要详情：

Abstract:

Background: The incidence of HCC is significantly higher in males (M) than females (F). Preclinical models suggest a role for estrogen in attenuating progression of HCC by various mechanisms such Il-6 suppression or estrogen receptor α-mediated inhibition of NF-κB activity. We investigated the impact of age and gender on survival in patients with HCC using the SEER data.

Methods: We identified all patients diagnosed with HCC (ICD-O-3 Site code C22.0 and Histology Code 8170-8175) from 1988 to 2009 from the SEER registry. Pts with information on gender, age, ethnic background, and staging were included in the analysis. Exclusion criteria included fibrolamellar histology, diagnosis at autopsy or by death certificate, and absence of survival data. Hazard ratios (HR) for survival were derived using Cox regression model adjusted for race, year of diagnosis, marital status, treatment, birthplace, differentiation and tumor size.

Results: A total of 38,250 pts were identified; 76% males; 50% White, 12% African American, 21% Asian, 16% Hispanic, and 1% Native American. 45% had liver limited disease (44%M, 50%F), 37% had macrovascular invasion (37%M, 35%F), 18% had metastatic disease (19%M, 15%F). Treatment information was available for pts diagnosed after 1998 (n=32,938): 11% received liver directed therapy, 11% had surgical resection, and 7% underwent liver transplantation. Median age at diagnosis was 61 years for M versus 68 years for F. HR for OS of F versus M was 0.83 (95%CI:0.78-0.89) for pts < 55 years old. In contrast, the OS HR of F versus M was 0.95 (95%CI:0.92-0.98) for pts ≥ 55 years old and 0.98 (95%CI: 0.94-1.01) for pts ≥ 65 years old. The F vs. M (<55 yrs old) HR for OS by stage of disease was: liver limited disease: HR 0.90, CI: 0.81-1.01; macrovascular invasion: HR 0.81, CI: 0.73-0.89; metastatic disease, HR 0.80, CI: 0.70-0.92.

Conclusions: Females under the age of 55 appear to have superior survival compared to males with HCC based on a SEER data analysis. This finding is in line with preclinical reports of estrogen attenuation of HCC development and progression.

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