Estrogen Replacement Reduces Risk and Increases Survival Times of Women With Hepatocellular Carcinoma

Manal M. Hassan*, Gehan Botrus, Reham Abdel-Wahab, Robert A. Wolff, Donghui Li, David Tweardy, Alexandria T. Phan, Ernest Hawk, Milind Javle, Ju Seog Lee, Harrys A. Torres, Asif Rashid, Renato Lenzi, Hesham M. Hassabo, Yasmin Abaza, Ahmed S. Shalaby, Sahin Lacin, Jeffrey Morris, Yehuda Z. Patt, Christopher I. AmosSaira A. Khaderi, John A. Goss, Prasun K. Jalal, Ahmed O. Kaseb

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Background & Aims: Environmental factors have been identified that affect risk of hepatocellular carcinoma (HCC), but little is known about the effects of sex hormones on liver cancer development or outcome. The authors investigated whether menopause hormone therapy (MHT) affects risk, age at onset, or outcome of HCC. Methods: We performed a case–control study of 234 female patients treated for HCC at a tertiary medical center and with 282 healthy women (controls) from January 1, 2004 through May 31, 2015. We collected detailed information on environmental exposures, ages of menarche and menopause, hysterectomies, and uses of birth control and MHT. We performed multivariable logistic and Cox regression analyses to determine the independent effects of factors associated with women on risk and clinical outcome in HCC. The primary outcomes were effect of MHT on HCC risk, the relationship between MHT with hepatitis virus infection on HCC development, and effect of MHT on age at HCC onset or survival after diagnosis of HCC. Results: The estimated adjusted odds ratio (AOR) for HCC in women who ever used estrogen was 0.53 (95% confidence interval [CI], 0.32–0.88). This association was supported by the older age of HCC onset among estrogen users (mean, 64.5 ± 0.9 years) vs nonusers (mean 59.2 ± 1.1 years; P =.001) and the reduced risk of HCC among long-term users (more than 5 years) (AOR, 0.36; 95% CI, 0.20–0.63). Users of estrogen also had a reduced risk for hepatitis-associated HCC: AOR for users, 4.37 (95% CI, 1.67–11.44) vs AOR for nonusers, 17.60 (95% CI, 3.88–79.83). Estrogen use reduced risk of death from HCC (hazard ratio, 0.55; 95% CI, 0.40–0.77; P =.01). Median overall survival times were 33.5 months for estrogen users (95% CI, 25.7–41.3 months) and 24.1 months for nonusers (95% CI, 19.02–29.30 months; P =.008). Conclusion: In a case–control study of women with HCC vs female control subjects at a single center, we associated use of estrogen MHT with reduced risk of HCC and increased overall survival times of patients with HCC. Further studies are needed to determine the benefits of estrogen therapy for women and patients with HCC, and effects of tumor expression of estrogen receptor.

Original languageEnglish (US)
Pages (from-to)1791-1799
Number of pages9
JournalClinical Gastroenterology and Hepatology
Issue number11
StatePublished - Nov 2017
Externally publishedYes


  • liver tumor
  • mortality
  • reduction
  • risk factor

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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