Tseng GW, Lin MC, Lai SW, Peng CY, Chuang PH, Su WP, Kao JT, Lai HC. Do peripartum and postmenopausal women with primary liver cancer have a worse prognosis? A nationwide cohort in Taiwan. World J Hepatol 2021; 13(11): 1766-1776 [PMID: 34904044 DOI: 10.4254/wjh.v13.i11.1766]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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.
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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
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.
Research objectives
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.
Research methods
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.
Research results
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).
Research conclusions
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.
Research perspectives
To further clarify the association between sexual hormone and PLC outcome, future studies with more detailed information and better-controlled confounders are required.
