Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients

Abstract

Background As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia. Methods From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients’ medical history, ultrasound scan, FibroScan and laboratory details were collected. Results Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32–7886) vs 153 (18–610), p = < 0.01, Alanine transferases 71 (5–937) vs 47 (8–271), p = < 0.001) and decreased platelet count 207 (33–941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative. Conclusions The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.

Overexpression of wild-type HRAS drives non-alcoholic steatohepatitis to hepatocellular carcinoma in mice

“…The observed decrease in BSEP ( Figure 2E ) and bile duct proliferation ( Figure 2B ) in the HRAS-HCC mouse model may obstruct the efflux of bile acids into the bile ducts, resulting in intrahepatic bile stasis and subsequent jaundice, possibly exacerbated by thrombus formation within the bile ducts. Severe cases may involve malignant transformation accompanied by primary intrabiliary malignancies or metastatic cancer invading the bile ducts ( Bittaye et al, 2023 ; Chen et al, 2021 ; Qin & Tang, 2003 ). In addition, hepatoma carcinoma cells leaving from cancer nests can migrate through the ECM, invade the vascular barrier, and colonize the portal vein, resulting in portal vein thrombosis, with some cancer cells disseminating to other organs, indicating metastasis ( Zhou et al, 2023 ).…”