Volume 28, Issue 2 (Iran South Med J 2025)
Iran South Med J 2025, 28(2): 611-621 |
Back to browse issues page
Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Aouragh H, Ait Kaci H, Haroun I, Zenia S, Abdellaoui L, Khelifi Touhami N A, et al . Gender-Related Differences in Clinical and Pathological Characteristics of Algerian Pa-tients with Hepatocellular Carcinoma: A 22 Year Retrospective Study. Iran South Med J 2025; 28 (2) :611-621
URL: http://ismj.bpums.ac.ir/article-1-2272-en.html
URL: http://ismj.bpums.ac.ir/article-1-2272-en.html
Hayet Aouragh1 
, Hayat Ait Kaci2 , Imene Haroun3 , Safia Zenia4 , Lynda Abdellaoui5 , Nadjet Amina Khelifi Touhami *6 , Nassim Ouchene5 , Dalila Tarzaali5 , Kamel Bentabak3 , Leila Saadi1
, Hayat Ait Kaci2 , Imene Haroun3 , Safia Zenia4 , Lynda Abdellaoui5 , Nadjet Amina Khelifi Touhami *6 , Nassim Ouchene5 , Dalila Tarzaali5 , Kamel Bentabak3 , Leila Saadi1
1- Laboratory of Eco-Biology Animals (L/E/B/A/), Higher Teachers’ Training School of Kouba Bachir El Ibrahimi, Algiers, Algeria
2- Department of Pathology, School of Medicine, Benyoucef Benkhedda University, Pierre & Marie Curie Center, Algeria
3- Department of Oncological Surgery, School of Medicine, Benyoucef Benkhedda University, Centre Pierre et Marie Curie, Algeria
4- Laboratory Research «Animal Health and Production», National Hight Veterinary School, Algiers, Algeria
5- Institute of Veterinary Sciences, Blida 1 University, Blida, Algeria
6- Institute of Veterinary Sciences, Blida 1 University, Blida, Algeria ,khelifi_nadjet@univ-blida.dz
2- Department of Pathology, School of Medicine, Benyoucef Benkhedda University, Pierre & Marie Curie Center, Algeria
3- Department of Oncological Surgery, School of Medicine, Benyoucef Benkhedda University, Centre Pierre et Marie Curie, Algeria
4- Laboratory Research «Animal Health and Production», National Hight Veterinary School, Algiers, Algeria
5- Institute of Veterinary Sciences, Blida 1 University, Blida, Algeria
6- Institute of Veterinary Sciences, Blida 1 University, Blida, Algeria ,
Abstract: (137 Views)
Background: Hepatocellular carcinoma (HCC), the most common primary liver malignancy, presents notable sex-based differences in incidence and progression. This study investigated gender-related variations in clinical, biological, and histopathological features among Algerian patients with HCC undergoing surgical resection, aiming to elucidate regional patterns and potential sex-specific risk profiles.
Materials and Methods: This retrospective observational study included 98 patients diagnosed with HCC and treated surgically between 1998 and 2019 at the Pierre and Marie Curie Center in Algiers. Data were extracted from medical records and included demographics, liver function tests, tumor size and grade, cirrhosis status, etiology, Child-Pugh classification, alpha-fetoprotein (AFP) levels, and serum creatinine. Statistical analyses assessed sex-related differences and associations between biological markers and tumor characteristics.
Results: The cohort comprised 70 men (71.4%) and 28 women (28.6%), with no significant age difference (p=0.108). Cirrhosis was present in 65.3% of cases, with viral hepatitis (48.9%) and alcohol-related liver disease (22.4%) as leading causes. Tumor size, Child-Pugh class, and most liver function parameters showed no significant sex differences. However, men had significantly higher serum creatinine levels (p=0.004), with all elevated values occurring in male patients (p=0.002). AFP levels did not differ by sex but were significantly elevated in moderately differentiated tumors (p=0.031).
Conclusion: Sex had limited influence on tumor and liver characteristics, except for renal function, which was notably impaired in males. AFP’s association with histological grade reinforces its prognostic value in Algerian patients with HCC.
Materials and Methods: This retrospective observational study included 98 patients diagnosed with HCC and treated surgically between 1998 and 2019 at the Pierre and Marie Curie Center in Algiers. Data were extracted from medical records and included demographics, liver function tests, tumor size and grade, cirrhosis status, etiology, Child-Pugh classification, alpha-fetoprotein (AFP) levels, and serum creatinine. Statistical analyses assessed sex-related differences and associations between biological markers and tumor characteristics.
Results: The cohort comprised 70 men (71.4%) and 28 women (28.6%), with no significant age difference (p=0.108). Cirrhosis was present in 65.3% of cases, with viral hepatitis (48.9%) and alcohol-related liver disease (22.4%) as leading causes. Tumor size, Child-Pugh class, and most liver function parameters showed no significant sex differences. However, men had significantly higher serum creatinine levels (p=0.004), with all elevated values occurring in male patients (p=0.002). AFP levels did not differ by sex but were significantly elevated in moderately differentiated tumors (p=0.031).
Conclusion: Sex had limited influence on tumor and liver characteristics, except for renal function, which was notably impaired in males. AFP’s association with histological grade reinforces its prognostic value in Algerian patients with HCC.
Keywords: Hepatocellular carcinoma, Gender differences, Cirrhosis, Alpha-fetoprotein, Tumor differentiation, Algeria
Type of Study: Original |
Subject:
Pathology
Received: 2025/07/13 | Accepted: 2025/09/28 | Published: 2025/11/22
Received: 2025/07/13 | Accepted: 2025/09/28 | Published: 2025/11/22
References
1. Rumgay H, Arnold M, Ferlay J, et al. Global burden of primary liver cancer in 2020 and predictions to 2040. J Hepatol 2022; 77(6): 1598-1606. [DOI]
2. Oh JH, Jun DW. The latest global burden of liver cancer: A past and present threat. Clin Mol Hepatol 2023; 29(2): 355-357. [DOI]
3. Singh SP, Madke T, Chand P. Global epidemiology of hepatocellular carcinoma. J Clin Exp Hepatol 2025; 15(2): 102446. [DOI]
4. Llovet JM, Kelley RK, Villanueva A, et al. Author correction: Hepatocellular carcinoma. Nat Rev Dis Primers 2024; 10(1). [DOI]
5. Celsa C, Stornello C, Giuffrida P, et al. Direct-acting antiviral agents and risk of hepatocellular carcinoma: Critical appraisal of the evidence. Ann Hepatol 2022; 27: 100568. [DOI]
6. Sharafi H, Alavian SM. The rising threat of hepatocellular carcinoma in the Middle East and North Africa region: Results from Global Burden of Disease Study 2017. Clin Liver Dis 2020; 14(6): 219-223. [DOI]
7. Bahri O, Ezzikouri S, Alaya-Bouafif NB, et al. First multicenter study for risk factors for hepatocellular carcinoma development in North Africa. World J Hepatol 2011; 3(1): 24-30. [DOI]
8. Phipps M, Livanos A, Guo A, et al. Gender matters: characteristics of hepatocellular carcinoma in women from a large, multicenter study in the United States. Am J Gastroenterol 2020; 115(9): 1486-1495. [DOI]
9. Dong M, Cioffi G, Wang J, et al. Sex differences in cancer incidence and survival: A pan-cancer analysis. Cancer Epidemiol Biomarkers Prev 2020; 29(7): 1389-1397. [DOI]
10. Yang D, Hanna DL, Usher J, et al. Impact of sex on the survival of patients with hepatocellular carcinoma: A Surveillance, Epidemiology, and End Results analysis. Cancer 2014; 120(23): 3707-3716. [DOI]
11. Ho JKH, Thurairajah PH, Leo J, et al. Sex differences in hepatocellular carcinoma. Hepatoma Res 2024; 10: 53. [DOI]
12. Toniutto P, Shalaby S, Maméli L, et al. Role of sex in liver tumor occurrence and clinical outcomes: A comprehensive review. Hepatology 2024; 79(5): 1141-1157. [DOI]
13. Lonardo A, Ballestri S, Nascimbeni F, et al. Sex disparity in hepatocellular carcinoma owing to NAFLD and non-NAFLD etiology: Epidemiological findings and pathobiological mechanisms. Hepatoma Res 2020; 6: 83. [DOI]
14. Radu IP, Scheiner B, Schropp J, et al. The influence of sex and age on survival in patients with hepatocellular carcinoma. Cancers (Basel) 2024; 16(23): 4023. [DOI]
15. Ladenheim MR, Kim NG, Nguyen P, et al. Sex differences in disease presentation, treatment and clinical outcomes of patients with hepatocellular carcinoma: A single-centre cohort study. BMJ Open Gastroenterol 2016; 3(1): e000107. [DOI]
16. Pang C, Li JM, Wang Z, et al. Age-dependent female survival advantage in hepatocellular carcinoma: A multicenter cohort study. Clin Gastroenterol Hepatol 2024; 22(2): 305-314. [DOI]
17. Arora SP, Liposits G, Caird S, et al. Hepatocellular carcinoma in older adults: A comprehensive review by Young International Society of Geriatric Oncology. J Geriatr Oncol 2020; 11(4): 557-565. [DOI]
18. Akarca US, Unsal B, Sezgin O, et al. Characteristics of newly diagnosed hepatocellular carcinoma patients across Turkey: Prospective multicenter observational 3K registry study. Turk J Gastroenterol 2021; 32(12): 1019-1028. [DOI]
19. Torkashvand Z, Mahjub H, Soltanian AR, et al. Comparison of Ordinal Response Modeling Methods like Decision Trees, Ordinal Forest and L1 Penalized Continuation Ratio Regression in High Dimensional Data. Iran South Med J. 2021; 24(5): 454-468. [DOI]
20. Wu EM, Wong LL, Hernandez BY, et al. Gender differences in hepatocellular cancer: Disparities in nonalcoholic fatty liver disease/steatohepatitis and liver transplantation. Hepatoma Res 2018; 4: 66. [DOI]
21. Rich NE, Murphy CC, Yopp AC, et al. Sex disparities in presentation and prognosis of 1110 patients with hepatocellular carcinoma. Aliment Pharmacol Ther 2020; 52(4): 701-709. [DOI]
22. Liao CY, Lee CY, Wei CY, et al. Differential prognosis in male and female patients with hepatocellular carcinoma. J Chin Med Assoc 2022; 85(5): 554-565. [DOI]
23. Tsai MC, Kee KM, Chen YD, et al. Excess mortality of hepatocellular carcinoma and morbidity of liver cirrhosis and hepatitis in HCV-endemic areas in an HBV-endemic country: Geographic variations among 502 villages in southern Taiwan. J Gastroenterol Hepatol 2007; 22(1): 92-98. [DOI]
24. Baxmann AC, Ahmed MS, Marques NC, et al. Influence of muscle mass and physical activity on serum and urinary creatinine and serum cystatin C. Clin J Am Soc Nephrol 2008; 3(2): 348-354. [DOI]
25. Johnson PJ, Berhane S, Kagebayashi C, et al. Assessment of liver function: the ALBI grade. J Clin Oncol 2015; 33(6): 550-558. [DOI]
26. Delanaye P, Mariat C. The applicability of eGFR equations to different populations. Nat Rev Nephrol 2013; 9(9): 513-522. [DOI]
27. Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. J Hepatol 2022; 76(3): 681-693. [DOI]
28. Hanif H, Ali MJ, Susheela AT, et al. Update on the applications and limitations of alpha-fetoprotein for hepatocellular carcinoma. World J Gastroenterol 2022; 28(2): 216-229. [DOI]
29. Huang C, Xiao X, Zhou L, et al. Chinese expert consensus on clinical application of AFP/AFP-L3%/DCP using GALAD and similar algorithms in HCC. J Clin Lab Anal 2023; 37(23-24): e24990. [DOI]
30. Singal AG, Tiro J, Li X, et al. Hepatocellular carcinoma surveillance among patients with cirrhosis in a population-based integrated health care delivery system. J Clin Gastroenterol 2017; 51(7): 650-655. [DOI]
31. Kanwal F, Khaderi S, Singal AG, et al. Risk stratification model for hepatocellular cancer in patients with cirrhosis. Clin Gastroenterol Hepatol 2023; 21(13): 3296-3304. [DOI]
32. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival of patients with hepatocellular carcinoma: A systematic review and meta-analysis. PLoS Med 2014; 11(4): e1001624. [DOI]
33. Daher D, Seif El Dahan K, Rich NE, et al. Hepatocellular carcinoma screening in a contemporary cohort of at-risk patients. JAMA Netw Open 2024; 7(4): e248755. [DOI]
34. Chi X, Jiang L, Yuan Y, et al. Comparison of clinicopathologic characteristics between AFP-negative and AFP-positive hepatocellular carcinoma patients from Eastern and Southern China. BMC Gastroenterol 2022; 22(1): 202. [DOI]
35. Mahi-Birjand M, Shabani A R, Khosrojerdi A, et al. Investigating the Efficacy of Vaccination Against Hepatitis B in Families of Infected Patients: in a Hyperendemic Area of Iran. Iran South Med J 2024; 27 (2) :171-178. [Article]
36. Ismail M, et al. Management of liver cirrhosis in patients with hepatocellular carcinoma. Chin Clin Oncol 2013; 2(4): 34. [DOI]
37. Zhang J, Chen Y, Liu J, et al. Impact of thrombocytopenia on prognosis of HBV-related small hepatocellular carcinoma: Propensity score matched analysis. World J Surg Oncol 2021; 19(1): 46. [DOI]
38. Wei Z, Zhang Y, Lu H, et al. Serum alpha-fetoprotein as a predictive biomarker for tissue alpha-fetoprotein status and prognosis in patients with hepatocellular carcinoma. Transl Cancer Res 2022; 11(4): 669-677. [DOI]
39. Montal R, Andreu-Oller C, Bassaganyas L, et al. Molecular portrait of high alpha-fetoprotein in hepatocellular carcinoma: Implications for biomarker-driven clinical trials. Br J Cancer 2019; 121(4): 340-343. [DOI]
40. Liu C, Xiao GQ, Yan LN, et al. Value of α-fetoprotein in association with clinicopathological features of hepatocellular carcinoma. World J Gastroenterol 2013; 19(11): 1811-1819. [DOI]
Send email to the article author
| Rights and Permissions | |
 |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
