BETTER SURVIVAL IN WOMEN WITH RESECTED HEPATOCELLULAR-CARCINOMA IS NOT RELATED TO TUMOR PROLIFERATION OR EXPRESSION OF HORMONE RECEPTORS

Objective: There is a well known male predominance in hepatocellular c arcinoma (HCC). Moreover, female patients with HCC have better surviva l;and lower recurrence rates after surgical resection. We previously s howed that the better prognosis in female patients is related to a hig her incidence of tumor encapsulation and less invasive tumors. However , the underlying mechanism is still obscure. Methods: In this study, w e examined the cell proliferative indices (expression of proliferative cell nuclear antigen (PCNA) and Ki-67 antigen using MIB1 antibody) an d expression of the estrogen and progesterone receptors (ERs and PRs, respectively) in 71 patients with resected HCC. These were correlated with the pathological features of the tumors and the survival rates of patients. Results: Female patients with HCC had significantly better actuarial and disease-free survival rates than male patients (p = 0.01 0 and 0.004, respectively). Tumor PCNA scores, represented by positive ly stained nuclei per 1000 tumor cells, were significantly higher in t umors showing venous permeation (p = 0.034), positive resection margin s (p = 0.011), and absence of bile production (p = 0.008). Higher tumo r MIB1 scores were seen in tumors that had poorer cellular differentia tion (p = 0.002) and no tumor capsules (p = 0.042). However, both tumo r PCNA and MIB1 scores did not differ significantly between female and male patients. ERs were detected in the tumor cells in 23.9% of tumor s, and PRs were detected in 14.3%. Expression of both ER and PR was no t influenced by gender. Conclusions: Women with HCC had significantly better survival and lower tumor recurrence rates. However, significant differences in cellular proliferation indices and expression of ER an d PR were not observed between men and women to explain the difference in survival rate.