Women with hepatocellular carcinoma (HCC) are more likely to have non-alcoholic fatty liver disease (NAFLD) than men. Women are also more likely to develop hepatocellular carcinoma without having cirrhosis, reported researchers in a study published in The American Journal of Gastroenterology.

NAFLD is characterized by fat accumulation in the liver. Over time, fat in the liver, hepatitis B or C, heavy alcohol use and other causes of liver injury can lead to cirrhosis and liver cancer. Now that hep B can be prevented with a vaccine and hep C can be easily cured, fatty liver disease has become a leading cause of HCC.
Globally, HCC is the most common type of liver cancer and the fourth most common cause of death from cancer. Previously, HCC has been shown to occur in four times as many men as women. Liver cancer typically develops in people who have progressed to cirrhosis, but this is not always the case.

Since HCC in women has not been well studied, Meaghan Phipps, MD, of the Columbia University Irving Medical Center, in New York City, and colleagues set out to understand any gender variations in the development of this cancer .

The researchers included 5,327 adults with an imaging or biopsy-proven diagnosis of HCC, of whom 1,203 (23%) were women. These participants were diagnosed between January 2000 and June 2014 at five different academic medical centers. Women were older than men at the time of their diagnosis. The cause of their HCC was identified on the basis of imaging and clinical and tissue analyses.

The team found that the causes of liver disease varied between men and women. NAFLD was more common in women: 23% of them had the condition compared with 12% of men. On the other hand, alcoholic liver disease was more common in men: 15% of men had it compared with only 5% of women. Women were also more likely to have an unclear or unknown cause of liver disease compared with men (20% versus 12%).

The most common cause of liver disease in women was hepatitis C (29%). Hep C together with alcohol use (24%), hep C alone (22%) and alcohol alone (15%) were the most common causes of liver disease in men.

HCC in the absence of cirrhosis was more common in women than men (17% versus 10%). When seen by a doctor, women were found to have less advanced HCC than men.

Women were more likely to be treated with surgery than men (18% versus 11%), but they were less likely to undergo liver transplantation (14% versus 18%). Women also had a better overall survival than men at the one-year, three-year and five-year marks.

“Further investigation is warranted to explore potential mechanisms and implications for these gender differences, especially with noncirrhotic HCC,” wrote the researchers.

Click here to read the study abstract in The American Journal of Gastroenterology.