Sex difference in the development of hepatocellular carcinoma after direct‐acting antiviral therapy in patients with HCV infection

Abstract

Sex differences in the predictors for HCC development after direct‐acting antiviral (DAA) therapy were investigated. DAA therapy was given to 1438 (663 male, 775 female) patients. Sex differences in the HCC development rate and the factors contributing to HCC development after DAA therapy were investigated. Male patients had a significantly higher cumulative HCC incidence (log‐rank test, p=0.007). On multivariate analysis, the FIB‐4 index (HR=1.11; 95%CI 1.042‐1.202, p=0.002) and post‐treatment α‐fetoprotein (AFP) (HR=1.11; 95%CI 1.046‐1.197, p=0.001) were found to be independent factors that contributed to HCC development following DAA therapy in female patients, whereas only post‐treatment AFP (HR=1.090; 95%CI 1.024‐1.160, p=0.007) was an independent factor in male patients. The optimal post‐treatment AFP cut‐off values were set based on receiver operating characteristic curve analyses. The optimal post‐treatment AFP cut‐off value was much higher in female (6.0 ng/mL) than in male (3.5 ng/mL) patients. In conclusions both in male and female patients, post‐treatment AFP was an independent predictor of HCC development after DAA therapy. However, the cut‐off values differed between the sexes. In male patients, HCC could be seen in patients with relatively low post‐treatment AFP levels; more careful observation might be needed in such patients.