Gender Difference in the Association between Metabolic Factors and Hepatocellular Carcinoma
Menée en Chine auprès de 74 782 participants à un programme de dépistage et à l'aide de données du registre national des cancers (âge : au moins 30 ans ; durée médiane de suivi : 4,5 ans), cette étude identifie des facteurs de disparités de genre dans l'incidence du carcinome hépatocellulaire (99 cas)
A gender difference in hepatocellular carcinoma (HCC) that men have higher incidence than women—has long been noted and can be explained by the cross-talk between sex hormones and HBV/HCV virus. Whether metabolic factors yield similar sexual difference in non-HBV/HCV-HCC remains elusive.74,782 HBsAg/anti-HCV negative residents participating in the Keelung Community-Based Integrated Screening program were followed in 2000-2007. Incident HCC was identified by linkage to the Taiwan Cancer Registry. Cox proportional hazards regression models were used to estimate the association between metabolic factors and HCC stratified by sex. All statistical tests were two-sided.With 320,829 follow-up person-years, 99 developed HCC. The adjusted hazard ratios were 2.10 (95% CI = 1.07-4.13) and 3.71 (95% CI = 2.01-6.86) for prediabetes and diabetes, respectively, in males. The corresponding aHRs were 1.16 (95% CI = 0.48-2.83) and 1.47 (95% CI = 0.65-3.34) in females. Compared to normal weight (BMI 23-25), underweight (BMI<21, HR = 3.56, 95% CI = 1.18-10.8) and overweight (BMI 25-<27.3, HR = 3.81, 95% CI = 1.43 – 10.2 were associated with an elevated risk in men. The statistically significant gradient relationship per advanced BMI category was noted in females (adjusted HR = 1.41, 95% CI = 1.07-1.87). The HCC/fasting glucose (p = 0.046) and HCC/BMI (p = 0.03) associations were significantly modified by sex. Elevated AST, APRI fibrosis index and habitual alcohol consumption were related to HCC only in men while increased ALT and lower platelet levels predicted HCC risk in women.We found that BMI-HCC association were U-shape for men and linear for women, and the elevated HCC risk began from glucose impairment in men only. Whether good glycemic and weight control can reduce HCC risk warrants further investigation.