Clinical Features and Overall Survival of Females with Hepatocellular Carcinoma: A Retrospective Study and Review of the Literature in the Association of Southeast Asian Nations

Figures & data

Table 1 Demographic Data and Clinical Data of HCC Patients Classified by Age

Parameter	Total (n = 187)	< 65 Years (n = 88)	≥ 65 Years (n = 99)	P-value
Age (years; mean ± SD)	65.7 ± 11.9	55.3 ± 7.6	74.9 ± 6.1	0.282
^†Underlying disease
Essential hypertension	49 (30.1%)	15 (19.2%)	34 (40.0%)	0.004
Diabetes mellitus	47 (28.8%)	14 (18.0%)	33 (28.8%)	0.003
Dyslipidemia	37 (22.7%)	8 (10.3%)	29 (34.1%)	<0.001
Family history of HCC	4 (2.5%)	3 (3.9%)	1 (1.2%)	0.350
^‡Active alcohol drinking	12 (6.8%)	8 (9.8%)	4 (4.3%)	0.149
^§Clinical presentations
Asymptomatic	69 (43.9%)	35 (46.1%)	34 (42.0%)	0.607
Weight loss	29 (18.5%)	13 (17.1%)	16 (19.8%)	0.669
Abdominal pain	27 (17.2%)	12 (15.8%)	15 (18.5%)	0.651
Evidence of cirrhosis	175 (94.6%)	81 (93.1%)	94 (95.9%)	0.520
^§Physical examination
Hepatomegaly	32 (20.4%)	18 (24.0%)	14 (17.3%)	0.282
Ascites	31 (19.8%)	15 (20.0%)	16 (19.5%)	0.939
Splenomegaly	8 (5.1%)	4 (5.3%)	4 (4.9%)	1.000
^‡Cause of chronic liver disease
HBV	70 (39.8%)	45 (54.9%)	25 (26.6%)	<0.001
NASH	49 (27.8%)	24 (12.2%)	39 (41.5%)	<0.001
HCV	47 (26.7%)	23 (28.1%)	24 (25.5%)	0.707
Alcohol	10 (5.7%)	5 (6.1%)	5 (5.3%)	1.000
Others	3 (1.7%)	0	3 (3.2%)	0.249
^¶Child-Pugh
A	65 (39.2%)	31 (40.3%)	34 (38.2%)	0.787
B	74 (44.6%)	33 (42.9%)	41 (46.1%)	0.678
C	27 (16.3%)	13 (16.9%)	14 (15.7%)	0.841
MELD-Na score (mean ± SD)	12.8±6.1	12.7±6.2	12.9±6.0	0.873
Laboratory values (mean ± SD)
Hemoglobin (g/dL)	11.4 ± 1.7	11.57 ± 1.6	11.3 ± 1.9	0.230
Platelet (10^3/μL)	150.9 ± 94.2	153.2 ± 107.5	148.9 ± 81.6	0.765
Total bilirubin (mg/dL)	2.1 ± 3.4	2.3 ± 3.4	2.0 ± 3.3	0.506
ALT (U/L)	61.3 ± 50.2	64.4 ± 40.8	58.7 ± 57.2	0.447
AST (U/L)	120.1 ± 128.9	140.3 ± 142.2	102.8 ± 114.1	0.056
Albumin (g/dL)	2.9 ± 0.7	2.9 ± 0.7	2.9 ± 0.7	0.721
Prothrombin time (sec)	14.8 ± 2.0	15.1 ± 2.0	14.59 ± 2.0	0.960
Survival
6-month survival rate	100 (73.0%)	51 (76.1%)	49 (70.0%)	0.420
1-year survival rate	88 (65.7%)	47 (71.2%)	41 (60.3%)	0.183
2-year survival rate	69 (54.8%)	39 (65.0%)	30 (45.5%)	0.028

Notes: ^†(n = 163), ^‡(n = 176), ^§(n = 157), ¶(n = 166).

Abbreviations: SD, standard deviation; HCC, hepatocellular carcinoma; HBV, hepatitis B virus; NASH, non-alcoholic steatohepatitis; HCV, hepatitis C virus; MELD, model for end-stage liver disease; ALT, alanine aminotransferase; AST, aspartate aminotransferase.

Table 2 Clinical Parameters and Management of Female HCC Patients

Parameter	Total (n = 184)	< 65 Years (n = 87)	≥ 65 Years (n = 97)	P-value
^†BCLC staging
Early	70 (40.2%)	33 (40.2%)	37 (40.2%)	0.997
Intermediate	51 (29.3%)	30 (36.6%)	21 (22.8%)	0.047
Advanced	53 (30.5%)	19 (23.2%)	34 (37.0%)	0.049
^‡Number of mass
Single	91 (49.5%)	42 (48.3%)	49 (50.5%)	0.762
Multiple	93 (50.5%)	45 (51.7%)	48 (49.5%)	0.762
Major vessel invasion	39 (21.1%)	14 (16.1%)	25 (25.8%)	0.109
Extrahepatic metastasis	19 (10.3%)	9 (10.3%)	10 (10.3%)	0.994
Ruptured HCC	19 (10.3%)	9 (10.3%)	10 (10.3%)	0.994
^§Pathology
Well differentiated	2 (13.3%)	2 (25%)	0	0.467
Moderately differentiated	10 (66.7%)	4 (50.0%)	6 (87.7%)	0.282
Poorly differentiated	3 (20.0%)	2 (25.0%)	1 (14.3%)	1.000
^¶TP 53 gene positive	2 (18.2%)	2 (33.3%)	0	0.455
Treatment
Surgery	13 (7.0%)	7 (8.0%)	6 (6.1%)	0.611
RFA	56 (30.0%)	29 (33.0%)	27 (27.3%)	0.397
TACE	66 (35.3%)	33 (37.5%)	33 (33.3%)	0.552
Palliative care	71 (38%)	29 (33%)	42 (42.4%)	0.183

Notes: ^†(n = 174), ^‡(n = 184), ^§(n = 15), ¶(n = 11).

Abbreviations: BCLC, Barcelona clinic liver cancer; HCC, hepatocellular carcinoma; RFA, radiofrequency ablation; TACE, transarterial chemoembolization.

Figure 1 Median survival time with each management strategy.

Figure 2 One-year survival rate related to BCLC staging and serum hypoalbuminemia.

Table 3 Clinical Characteristic and Outcomes of HCC Patients in the ASEAN

Study	Country	Study Type	Year	Number of Female Patients with HCC	Age (Years, Mean ± SD)	Cause of Chronic Liver Disease	Child-Pugh Score	BCLC Staging	Survival	Notes
This study	Thailand	Retrospective study	2021	187 (100%)	65.7 ± 11.9	HBV = 39.8%	Child-Pugh B = 44.6%	40.2% were early BCLC staging (stage 0 and A)	Median survival = 6.0 months
Le^Citation31	Vietnam	Retrospective study	2019	20 (10.1%)	N/A	HBV = 80%	Child-Pugh A = 80%	Advanced stage of HCC = 100%	N/A	Advanced stage of HCC was defined as BCLC stage C or D with the presence of portal venous thrombosis or extrahepatic metastasis.
					Median age of all patients = 57 years
Goh^Citation32	Singapore	Retrospective study	2017	252 (18.0%)	N/A	N/A	N/A	N/A	N/A	This study included HCC patients from January 1, 1988 to April 30, 2016 and divided them into 2 groups: 764 patients were in cohort 1 spanning 1988–2002 (C1) and 637 patients were in cohort 2 spanning 2003–1026 (C2).
					C1 group = 60.1 ± 13.0 years, C2 group = 63.5 ± 10.9 years	HBV = 72.7% of all patients	Child-Pugh A = 46.7% of all patients	BCLC stage C = 43.5% of all patients	Median survival of C1 vs C2 were 3.8 vs 18.6 months
Norsa’adah^Citation33	Malaysia	Retrospective study	2013	45 (21.4%)	N/A	N/A	N/A	N/A	N/A	The significant prognostic factors were Malay ethnicity (AHR 1.6; 95% CI 1.0–2.5, p = 0.017), no chemotherapy (AHR 1.7; 95% CI 1.1–2.5; p=0.030), and Child-Pugh class C (AHR 2.6; 95% CI 1.4–4.9, p = 0.002).
					38.1% of all patients were aged ≥60 years	The majority was HBV = 57.6% of all patients		63.3% of all patients were in BCLC stage C	Median survival of all patients = 1.9 months
Tangkijvanich^Citation12	Thailand	Retrospective study	2004	39 (13.0%)	56.4 ± 15.2	HBV = 85.7%	N/A	N/A	N/A
									Median survival of all patients = 5 months

Abbreviations: HCC, hepatocellular carcinoma; ASEAN, Association of Southeast Asian Nations; SD, standard deviation; BCLC, Barcelona Clinic Liver Cancer; HBV, hepatitis B virus; N/A, not available; AHR, adjusted hazard ratio; CI, confidence interval.

Le VQ, Nguyen VH, Nguyen VH, et al. Epidemiological characteristics of advanced hepatocellular carcinoma in the northern region of Vietnam. Cancer Control. 2019;26(1):1073274819862793. doi:10.1177/1073274819862793

 Web of Science ®Google Scholar

Goh GB, Li JW, Chang PE, Chow KY, Tan CK. Deciphering the epidemiology of hepatocellular carcinoma through the passage of time: a study of 1401 patients across 3 decades. Hepatol Commun. 2017;1(6):564–571. doi:10.1002/hep4.1059

 Web of Science ®Google Scholar

Norsa’adah B, Nurhazalini-Zayani CG. Epidemiology and survival of hepatocellular carcinoma in north-east Peninsular Malaysia. Asian Pac J Cancer Prev. 2013;14(11):6955–6959. doi:10.7314/apjcp.2013.14.11.6955

 Google Scholar

Tangkijvanich P, Mahachai V, Suwangool P, Poovorawan Y. Gender difference in clinicopathologic features and survival of patients with hepatocellular carcinoma. World J Gastroenterol. 2004;10(11):1547–1550. doi:10.3748/wjg.v10.i11.1547

 Web of Science ®Google Scholar