{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:58:15Z","timestamp":1790956695062,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Sex is a well-recognized factor associated with hepatocellular carcinoma (HCC) incidence, but its association with mortality is unclear.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the association between sex and the risk of overall, liver-related, and non\u2013liver-related mortality among patients with HCC.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was conducted among patients with HCC in 17 centers from 5 countries and regions (2000-2023). Male and female patients with HCC who had balanced baseline characteristics via inverse probability of treatment weighting (IPTW) were included, with a propensity score\u2013matched cohort included for sensitivity analyses. Data were analyzed between July 10 and September 8, 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n Male vs female sex.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Overall, liver-related, and non\u2013liver-related mortality.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 8594 patients with HCC (mean [SD] age, 63.3 [10.9] years; 6214 male [72.3%]; 5644 Asian [65.7%], 458 Black [5.3%], 615 Hispanic [7.2%], and 1784 White [20.8%]), 4567 were from Asia (53.1%), 6327 had cirrhosis (73.6%), and 6617 had viral etiology (77.0%). In the unmatched cohort, males had a higher overall mortality rate per 100 person-years than females in the total cohort (15.9 [95% CI, 15.3-16.4] vs 13.3 [95% CI, 12.5-14.1];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and in Asian (14.1 [95% CI, 13.5-14.7] vs 11.1 [95% CI, 10.3-12.0];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), Asia region (14.4 [95% CI, 13.6-15.2] vs 10.8 [95% CI, 9.9-11.8];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), cirrhosis (17.6 [95% CI, 16.9-18.3] vs 14.4 [95% CI, 13.5-15.4];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and hepatitis B (13.6 [95% CI, 12.7-14.5] vs 10.0 [95% CI, 8.6-11.5];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and C (15.8 [95% CI, 15.0-16.6] vs 13.4 [95% CI, 12.4-14.6];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) subgroups. In the IPTW-matched cohort, male sex was associated with increased overall mortality in the full cohort (adjusted hazard ratio [aHR], 1.14 [95% CI, 1.05-1.23];\n P<\/jats:italic>\n \u2009=\u2009.002) and in Asian (aHR, 1.22 [95% CI, 1.10-1.36];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), Asia region (aHR, 1.23 [95% CI, 1.09-1.39];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), cirrhosis (aHR, 1.18 [95% CI, 1.08-1.29];\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001), and viral (aHR, 1.15 [95% CI, 1.05-1.26];\n P<\/jats:italic>\n \u2009=\u2009.004) subgroups. Additionally, sex differences varied by liver disease etiology, with male sex having the highest aHR in the association with overall mortality among individuals with alcohol-associated liver disease (aHR, 1.90 [95% CI, 1.02-3.54];\n P<\/jats:italic>\n \u2009=\u2009.04), followed by those with hepatitis B (aHR, 1.22 [95% CI, 1.01-1.47];\n P<\/jats:italic>\n \u2009=\u2009.04) or C (aHR, 1.13 [95% CI, 1.02-1.26];\n P<\/jats:italic>\n \u2009=\u2009.03), but there was no association in patients with metabolic dysfunction\u2013associated steatotic liver disease. There was no significant sex difference for non\u2013liver-related mortality.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this study, sex disparities in HCC mortality existed but were heterogeneous across ethnic background and liver disease etiologies. These findings support incorporation of sex-based considerations in HCC management.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.37313","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T15:30:22Z","timestamp":1790955022000},"page":"e2637313","source":"Crossref","is-referenced-by-count":0,"title":["Sex Differences in Mortality Among Patients With Hepatocellular Carcinoma"],"prefix":"10.1001","volume":"9","author":[{"given":"Taotao","family":"Yan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California"},{"name":"Department of Infectious Diseases, The First Affiliated Hospital of Xi\u2019an Jiaotong University, Xi\u2019an, China"},{"name":"National Regional Infectious Diseases Center, Clinical Research Center for Infectious Diseases of Shaanxi, Xi\u2019an, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Lun","family":"Yeh","sequence":"additional","affiliation":[{"name":"Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan"},{"name":"Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan"},{"name":"Center for Metabolic Disorders and Obesity, Kaohsiung Medical University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Leong","sequence":"additional","affiliation":[{"name":"Henry D. 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Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yao-Chun","family":"Hsu","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology of Hepatology, E-Da Cancer Hospital\/I-Shou University, Kaohsiung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Landis","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Central Hospital, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Vutien","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, University of Washington School of Medicine, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruki","family":"Uojima","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, 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