{
  "abstract": "Importance: Sex is a well-recognized factor associated with hepatocellular carcinoma (HCC) incidence, but its association with mortality is unclear.\n\nObjective: To assess the association between sex and the risk of overall, liver-related, and non–liver-related mortality among patients with HCC.\n\nDesign, Setting, and Participants: 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–matched cohort included for sensitivity analyses. Data were analyzed between July 10 and September 8, 2025.\n\nExposures: Male vs female sex.\n\nMain Outcomes and Measures: Overall, liver-related, and non–liver-related mortality.\n\nResults: 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]; P < .001) and in Asian (14.1 [95% CI, 13.5-14.7] vs 11.1 [95% CI, 10.3-12.0]; P < .001), Asia region (14.4 [95% CI, 13.6-15.2] vs 10.8 [95% CI, 9.9-11.8]; P < .001), cirrhosis (17.6 [95% CI, 16.9-18.3] vs 14.4 [95% CI, 13.5-15.4]; P < .001), and hepatitis B (13.6 [95% CI, 12.7-14.5] vs 10.0 [95% CI, 8.6-11.5]; P < .001) and C (15.8 [95% CI, 15.0-16.6] vs 13.4 [95% CI, 12.4-14.6]; P < .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]; P = .002) and in Asian (aHR, 1.22 [95% CI, 1.10-1.36]; P < .001), Asia region (aHR, 1.23 [95% CI, 1.09-1.39]; P < .001), cirrhosis (aHR, 1.18 [95% CI, 1.08-1.29]; P < .001), and viral (aHR, 1.15 [95% CI, 1.05-1.26]; P = .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]; P = .04), followed by those with hepatitis B (aHR, 1.22 [95% CI, 1.01-1.47]; P = .04) or C (aHR, 1.13 [95% CI, 1.02-1.26]; P = .03), but there was no association in patients with metabolic dysfunction–associated steatotic liver disease. There was no significant sex difference for non–liver-related mortality.\n\nConclusions and Relevance: 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.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Gastroenterology and Hepatology, Stanford University Medical Center, Palo Alto, California",
    "Department of Infectious Diseases, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China",
    "National Regional Infectious Diseases Center, Clinical Research Center for Infectious Diseases of Shaanxi, Xi’an, China",
    "Hepatobiliary Division, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan",
    "Hepatitis Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan",
    "Center for Metabolic Disorders and Obesity, Kaohsiung Medical University, Kaohsiung, Taiwan",
    "Henry D. Janowitz Division of Gastroenterology, Mount Sinai Health System, New York, New York",
    "Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, Gifu, Japan",
    "Division of Gastroenterology and Hepatology, Shinmatsudo Central General Hospital, Chiba, Japan",
    "Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, South Korea",
    "Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota",
    "Department of Gastroenterology and Hepatology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan",
    "Virology and Liver Unit, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan",
    "Division of Gastroenterology of Hepatology, E-Da Cancer Hospital/I-Shou University, Kaohsiung, Taiwan",
    "Kaiser Permanente Central Hospital, Seattle, Washington",
    "Division of Gastroenterology, University of Washington School of Medicine, Seattle",
    "Department of Gastroenterology, Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan",
    "Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan",
    "Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron and Universitat Autònoma de Barcelona, Barcelona and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas del Instituto Carlos III, Barcelona, Spain",
    "Liver Diseases Group, Vall d’Hebron Research Institute, Barcelona, Spain",
    "San Jose Gastroenterology, San Jose, California",
    "Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan",
    "Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan",
    "Division of Gastroenterology and Hepatology, Veterans Affairs Palo Alto Health Care System, Palo Alto, California",
    "Department of Epidemiology and Population Health, Stanford University, Palo Alto, California"
  ],
  "article_type": null,
  "arxiv": null,
  "author_total": 30,
  "authors": [
    {
      "affs": [
        0,
        1,
        2
      ],
      "name": "Taotao Yan"
    },
    {
      "affs": [
        3,
        4,
        5
      ],
      "name": "Ming-Lun Yeh"
    },
    {
      "affs": [
        6
      ],
      "name": "Jennifer Leong"
    },
    {
      "affs": [
        7
      ],
      "name": "Hidenori Toyoda"
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    {
      "affs": [
        8
      ],
      "name": "Hiroshi Abe"
    },
    {
      "affs": [
        9
      ],
      "name": "Dae Won Jun"
    },
    {
      "affs": [
        10
      ],
      "name": "Lewis Roberts"
    },
    {
      "affs": [
        11,
        12
      ],
      "name": "Yasuhito Tanaka"
    },
    {
      "affs": [
        6
      ],
      "name": "Myron Schwartz"
    },
    {
      "affs": [
        13
      ],
      "name": "Yao-Chun Hsu"
    },
    {
      "affs": [
        14
      ],
      "name": "Charles Landis"
    },
    {
      "affs": [
        15
      ],
      "name": "Phillip Vutien"
    },
    {
      "affs": [
        16
      ],
      "name": "Haruki Uojima"
    },
    {
      "affs": [
        17
      ],
      "name": "Takashi Honda"
    },
    {
      "affs": [
        18,
        19
      ],
      "name": "Maria Buti"
    },
    {
      "affs": [
        20
      ],
      "name": "Huy Trinh"
    },
    {
      "affs": [
        21
      ],
      "name": "Eiichi Ogawa"
    },
    {
      "affs": [
        7
      ],
      "name": "Satoshi Yasuda"
    },
    {
      "affs": [
        13
      ],
      "name": "Cheng-Hao Tseng"
    },
    {
      "affs": [
        0
      ],
      "name": "Mayumi Maeda"
    },
    {
      "affs": [
        0
      ],
      "name": "Elsa Sola"
    },
    {
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        22
      ],
      "name": "Takanori Suzuki"
    },
    {
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        3,
        4,
        5
      ],
      "name": "Chung-Feng Huang"
    },
    {
      "affs": [
        3
      ],
      "name": "Pei-Chien Tsai"
    },
    {
      "affs": [
        3,
        4,
        5
      ],
      "name": "Chia-Yen Dai"
    },
    {
      "affs": [
        3,
        4,
        5
      ],
      "name": "Jee-Fu Huang"
    },
    {
      "affs": [
        3,
        4,
        5
      ],
      "name": "Wan-Long Chuang"
    },
    {
      "affs": [
        0,
        23
      ],
      "name": "Ramsey Cheung"
    },
    {
      "affs": [
        3,
        4,
        5
      ],
      "name": "Ming-Lung Yu"
    },
    {
      "affs": [
        0,
        24
      ],
      "name": "Mindie H. Nguyen"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/cd1vzg209dwzn.bib",
  "cited_by": 0,
  "doi": "10.1001/jamanetworkopen.2026.37313",
  "fulltext_url": null,
  "id": "cd1vzg209dwzn",
  "issns": [
    "2574-3805"
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  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
    ]
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  "openalex": "W7216553944",
  "pdf_url": null,
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-02",
  "publisher": "American Medical Association (AMA)",
  "ris": "https://research.draconitic.com/paper/cd1vzg209dwzn.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:46Z",
      "native_id": "10.1001/jamanetworkopen.2026.37313",
      "source": "crossref",
      "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2854758"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
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  ],
  "title": "Sex Differences in Mortality Among Patients With Hepatocellular Carcinoma",
  "title_text": "Sex Differences in Mortality Among Patients With Hepatocellular Carcinoma",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:19:46Z",
  "url": "https://research.draconitic.com/paper/cd1vzg209dwzn",
  "venue": "JAMA Network Open",
  "versions": []
}