| Background & aims: The incidence of hepatocellular carcinoma(HCC)in women is lower than that in men.The prognosis of female patients has been reported to be better than that of male patients,which is likely due to the protective effect of estrogen.The objectiv of the current study is to examine the prognosis of female versus male patients with intrahepatic cholangiocarcinoma(ICC),and to investigate the possible protective effect of estrogen for the survival outcomes among ICC patients using with stratification analysis based on the patient's age..Methods: Clinicopathological and follow-up data on consecutive patients with histopathologically proven ICC who underwent surgical resection between January 2009 and December 2012 at the Eastern Hepatobiliary Surgry Hospital were reviewed.Patients were divided into the male and female groups.Propensity score matching(PSM)was used to reduce the differences in baseline characteristics between the groups.The endpoints of this study were overall survival(OS)and time to recurrence(TTR).Variables were expressed as number(percentage)or mean(standard deviation).Continuous variables were compared using the paired t test or Mann-Whitney U test,as appropriate.Categorical variables were compared using the chi-square test or Fisher's exact test.Survival analysis was performed using the Kaplan-Meier method.The survival curves between the two groups were compared using the Log-Rank test.The Cox hazard ratio model was used for univariate and multivariate analyses to identify independent risk factors for OS and recurrence..Results: There were 976 patients who were included in the study,of which 322 were female and 654 were male.The 1-,3-,and 5-year OS rates for the male group were 60.2%,37.3%,and 27.7%,respectively;and the corresponding rates for the female group were 65.8%,40.4%,and 31.0%,respectively(P=0.380).The 1-,3-,and 5-year recurrence rates for the male group were 50.6%,67.4%,and 74.2%,respectively;and the corresponding rates for the female group were 44.4%,63.46%,69.6%,respectively(P = 0.123).On multivariate analyses,the independent risk factors for OS were CEA(HR: 1.435,95% CI: 1.172-1.757),CA19-9(1.426,1.203-1.69),tumor diameter(1.491,1.248-1.782),multiple tumors(1.442,1.219-1.705)and nodal metastasis(1.292,1.061-1.573).Those for recurrence were tumor diameter(1.575,1.311-1.891),multiple tumors(1.465,1.231-1.745),microvascular invasion(1.428,1.173-1.739)and nodal metastasis(1.249,1.019-1.529).After 1:1 PSM,a total of 626 patients were included,with 313 in each of the male and female groups.Multivariate analysis demonstrated that male(HR: 1.322,95% CI: 1.079-1.621),CEA(1.426,1.114-1.826),CA19-9(1.357,1.088-1.691),tumor diameter(1.508.1.206-1.887)and multiple tumors(1.512,1.231-1.857)were independent risk factors of OS;and male(HR: 1.337,95% CI: 1.088-1.645),tumor diameter(1.631,1.293-2.057),multiple tumors(1.524,1.230-1.889)and microvascular invasion(1.512,1.105-2.067)were independent risk factors of recurrence.and.The 1-,3-,and 5-year OS rates for the male group were 60.6%,35.9%,and 22.4%,respectively,which were lower than 66.4%,40.6%,and 31.1%,respectively,for the female group(P = 0.041).The corresponding recurrence rates for the male group were 51.5%,69.3%,and 83.9%,respectively,which were higher than 44.3%,63.6%,and 69.9%,respectively,for the female group(P = 0.041).After PSM,there were 352 patients younger than 55 years old,including 166 males and 186 females.Multivariate analysis showed that male(HR: 1.315,95% CI: 1.004-1.723),CEA(1.728,1.256-2.378),CA19-9(1.371,1.270-2.21)and multiple tumors(1.678,1.270-2.210)were independent risk factors affecting OS;and male(1.466,1.106-1.944),CEA(1.580,1.139-2.193),tumor diameter(1.459,1.072-1.986)and multiple tumors(1.762,1.316-2.359)were independent risk factors for recurrence.The 1-,3-,and 5-year OS rates for the male group were 59.1%,34.9%,and 21.6%,respectively,which were lower than 68.3%,42.1%,and 29.3%,respectively,for the female group(P = 0.040).The corresponding rates for recurrence for the male group were 51.2%,69.8%,and 88.3%,respectively,which were higher than 41.7%,59.3%,and 79.6%,respectively,for the female group(P = 0.016).In patients with hepatolithiasis aged 55 or older,the 1-,3-,and 5-year OS rates of male group were better than those of female group(P = 0.032),but there was no significant difference of the corresponding recurrence rates between the two groups(P = 0.150).However,in the patients without hepatolithiasis aged 55 or older,we found that there was no significant difference in the 1-,3-,and 5-year OS and the corresponding recurrence rates between male and female groups.Conclusions: After PSM,male was an independent risk factor for OS and recurrence for ICC patients.According to the age stratification,the prognosis of male group < 55 years old was worse than that of female group.Male was an independent risk factor of OS and reccurence.The prognosis of men ? 55 years old was no different from that of women,but the overall survival rate of men ? 55 years old with hepatolithiasis was better than that of women. |
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