Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Nov 27, 2021; 13(11): 1766-1776
Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1766
Do peripartum and postmenopausal women with primary liver cancer have a worse prognosis? A nationwide cohort in Taiwan
Guan-Woei Tseng, Mei-Chen Lin, Shih-Wei Lai, Cheng-Yuan Peng, Po-Heng Chuang, Wen-Pang Su, Jung-Ta Kao, Hsueh-Chou Lai
Guan-Woei Tseng, Department of Medicine, China Medical University, Taichung 40402, Taiwan
Mei-Chen Lin, Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
Shih-Wei Lai, Department of Family Medicine, China Medical University Hospital, Taichung 404, Taiwan
Cheng-Yuan Peng, Po-Heng Chuang, Wen-Pang Su, Jung-Ta Kao, Hsueh-Chou Lai, Center for Digestive Disease Department of Internal Medicine, China Medical University Hospital, Taichung 404, Taiwan
Hsueh-Chou Lai, School of Chinese Medicine, China Medical University, Taichung 404, Taiwan
Author contributions: Tseng GW did the study conception and design, and initial draft of the manuscript; Lin MC did the data analysis and interpretation, and initial draft of the manuscript; Lai SW, C Peng CY, Chuang PH, Su WP, Kao JT participated in the study conception; Lai HC did the data analysis and interpretation, manuscript drafting and revision. All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewers.
Informed consent statement: For more information about the usage of National Health Insurance Research Database (NHIRD), please refer to https://nhird.nhri.org.tw/en/Data_Protection.html
Conflict-of-interest statement: All authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at t674233@ms54.hinet.net.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hsueh-Chou Lai, MD, PhD, Professor, School of Chinese Medicine, China Medical University, No. 91 Xueshi Road, North District, Taichung 404, Taiwan. t674233@ms54.hinet.net
Received: April 27, 2021
Peer-review started: April 27, 2021
First decision: June 15, 2021
Revised: July 5, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: November 27, 2021
Processing time: 210 Days and 23.9 Hours
Abstract
BACKGROUND

While primary liver cancer (PLC) is one of the most common cancers around the world, few large-scale population-based studies have been reported that evaluated the clinical survival outcomes among peripartum and postmenopausal women with PLC.

AIM

To investigate whether peripartum and postmenopausal women with PLC have lower overall survival rates compared with women who were not peripartum and postmenopausal.

METHODS

The Taiwan National Health Insurance claims data from 2000 to 2012 was used for this propensity-score-matched study. A cohort of 40 peripartum women with PLC and a reference cohort of 160 women without peripartum were enrolled. In the women with PLC with/without menopause study, a study cohort of 10752 menopausal females with PLC and a comparison cohort of 2688 women without menopause were enrolled.

RESULTS

Patients with peripartum PLC had a non-significant risk of death compared with the non-peripartum cohort [adjusted hazard ratios (aHR) = 1.40, 95% confidence intervals (CI): 0.89-2.20, P = 0.149]. The survival rate at different follow-up durations between peripartum PLC patients and those in the non-peripartum cohort showed a non-significant difference. Patients who were diagnosed with PLC younger than 50 years old (without menopause) had a significant lower risk of death compared with patients diagnosed with PLC at or older than 50 years (postmenopausal) (aHR = 0.64, 95%CI: 0.61-0.68, P < 0.001). The survival rate of women < 50 years with PLC was significantly higher than older women with PLC when followed for 0.5 (72.44% vs 64.16%), 1 (60.57% vs 51.66%), 3 (42.92% vs 31.28%), and 5 year(s) (37.02% vs 21.83%), respectively (P < 0.001).

CONCLUSION

Peripartum females with PLC have no difference in survival rates compared with those patients without peripartum. Menopausal females with PLC have worse survival rates compared with those patients without menopause.

Keywords: Primary liver cancer; Peripartum and postmenopausal women; Prognosis; Nationwide cohort; Peripartum women; Postmenopausal women

Core Tip: This is the first nationwide study to evaluate the survival rate of peripartum and postmenopausal women with primary liver cancer (PLC) using the National Health Insurance Research Database in Taiwan. The results showed that patients with peripartum PLC had a non-significant risk of death compared with those in the non-peripartum cohort. Patients who were diagnosed with PLC younger than 50 years (without menopause) had a significantly lower risk of death compared with patients diagnosed with PLC at 50 years or older (after menopause). We believe that the results presented in this study provide important information on clinical applications.