Published online Nov 27, 2021. doi: 10.4254/wjh.v13.i11.1766
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
Primary liver cancer (PLC), the sixth most common cancer, accounts for the fourth leading cause of cancer-related death worldwide. Given the continuous rise of the global burden, there are increasing concerns about PLC outcomes in different populations.
For a long time, most studies about PLC put their focus on men due to higher incidence and riskier morbidities compared to women. Even with growing evidence on the protective effects of female sex hormones in animal research, few clinical cohorts pay attention to women with PLCs. Therefore, we are interested in the issue of how female reproductive status is related to the prognosis of PLCs.
This study aimed to assess whether peripartum and postmenopausal women with PLC have lower overall survival rates in a large cohort of subjects in Taiwan.
This is a retrospective cohort of the PLC prognosis among peripartum, non-peripartum, premenopausal, and postmenopausal women using the Taiwan National Health Insurance Research Database from 2000-2012. There were 200 eligible subjects enrolled in the study of peripartum PLC, whereas 13440 subjects enrolled in the research of menopausal PLC. 4:1 Propensity score matching was applied to adjust the covariates.
While the survival rate was overall lower in patients with peripartum PLC, there was no significant difference in the risk of death and the survival rate at different follow-up durations among patients with/without peripartum PLC. In the menopausal PLC cohort, significantly lower risk of death (aHR = 0.64, 95%CI: 0.61-0.68, P < 0.001) and higher survival rate when followed for 0.5 year (72.44% vs 64.16%), 1 year (60.57% vs 51.66%), 3 years (42.92% vs 31.28%), and 5 years were seen in patients diagnosed with PLC younger than 50 years old (without menopause) compared with patients diagnosed with PLC at or older than 50 years (with menopause).
According to our dataset, it is concluded that younger age and female hormonal factors may reduce the occurrence and deterioration of PLCs. Females with paripartum 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.
To further clarify the association between sexual hormone and PLC outcome, future studies with more detailed information and better-controlled confounders are required.