Increased hepatocellular carcinoma recurrence in women compared to men with high alpha fetoprotein at liver transplant
Journal Title: Annals of Hepatology - Year 2016, Vol 15, Issue 4
Abstract
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. Material and methods. 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 andLT, tumor burden, loco-regional therapy, and donor risk index. HCC recurrence was assessed by competing risks regression. Results. 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 timeshigher 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. Conclusion. 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.
Authors and Affiliations
Monika Sarkar, Jennifer Dodge, John Roberts, Norah Terrault, Francis Yao, Neil Mehta
Keywords
Related Articles
- EP ID EP78599
- DOI 10.5604/16652681.1202948
- Views 99
- Downloads 0
NISCH syndrome with hypothyroxinemia
Neonatal Ichthyosis Sclerosing Cholangitis (NISCH) syndrome is a rare autosomal recessive condition characterized by ichthyosis, sclerosing cholangitis and alopecia. Only 5 patients have been described till now. We repor...
Reversibility of liver fibrosis
Liver cirrhosis is a major cause of morbidity and mortality worldwide and has very limited therapeutic options. Regardless of the aetiology, hepatic fibrosis is a characteristic feature of chronic liver disease. Our know...
Diagnostic value of fibronectin discriminant score for predicting liver fibrosis stages in chronic hepatitis C virus patients
[b]Background[/b]. Several noninvasive predictive models were developed to substitute liver biopsy for fibrosis assessment. [b]Aim[/b]. To evaluate the diagnostic value of fibronectin which reflect extracellular matrix m...
Chilaiditi syndrome. An uncommon cause of crampy, upper abdominal pain
Glisson’s capsule blistering after hyperthermic intraperitoneal chemotherapy
Hypertermic intraperitoneal chemotherapy is a treatment option after cytorreduction of certain types of malignancies with peritoneal spread. Blistering of the Glisson’s capsule has not been previously reported as a conse...