Hepatocellular carcinoma in Senegal: epidemiological, clinical and etiological aspects about 229 cases at Hopital Principal de Dakar

Abstract

Hepatocellular carcinoma (HCC) is a major public health problem in Senegal, and the third most common cancer in terms of incidence. However, there are no recent data on the characteristics of this pathology in our country. The aim was to describe the epidemiological, clinical, aetiological and therapeutic aspects of HCC at Hôpital Principal de Dakar, Senegal. We did a descriptive retrospective study, including patients hospitalized from January 2012 to December 2017. We included 229 patients. The mean age was 47.4 years (21 - 88 years), and 77 patients (33.6%) were under 40 years of age. The sex ratio was 6.6. Twelve patients (5.2%) had a family history of 1 st degree cirrhosis or HCC. Ten patients (4.4%) were previously treated with nucleotide analogues. The most common clinical sign at diagnosis was abdominal pain (91.7%). Alpha-fetoprotein level was normal in 12.2% of patients, and greater than 400 ng/ml in 68.1% of cases. Abdominal ultrasound found nodular HCC in 122 patients (68.2%), infiltrative HCC in 19 patients (10.6%), and was normal in 38 cases (21.2%). Subjacent cirrhosis was detected in 71.3% of cases. Abdominal computed tomography (CT) scan showed compatible HCC lesions in 88.8% of cases. A histological diagnosis was obtained in 2 patients (0.9%). The most common etiological factor was hepatitis B virus (69.4%), characterized mostly by a younger age (p = 0.001). In 20.9% of cases, no aetiology was found. An advanced or terminal stage (BCLC C/D) was found in 217 cases (94.8%). The treatment was curative in 12 patients (5.2%), and palliative in 7 cases (3.1%). The evolution at one year was favourable in 6 patients (2.6%). Hepatocellular carcinoma (HCC) is a disease that mainly affects young male adults in Senegal. The main aetiological factor remains HBV infection. The diagnosis is made at an advanced stage and the prognosis very bad.

The Prognostic Values of Neutrophil-to-lymphocyte Ratio and Platelet-to-Lymphocyte Ratio at Baseline in Predicting the In-hospital Mortality in Black African Patients with Advanced Hepatocellular Carcinoma in Palliative Treatment: A Comparative Cohort Study

“…HCC is a challenging condition in sub-Saharan Africa because of its silent course and discovery at the end stage in most patients, the lack of medical facilities or expertise among physicians in-hospital for the administration of an appropriated treatment if necessary. 3 , 16 , 17 , 25–27 Our study demonstrates that one month survival was 28% of patients with advanced HCC survived at 30 days. The establishment of a simple and practical tool for routine utilization could be a better approach in these conditions to predict the mortality in such particular patients and to take the appropriate measure for patient treatment or assistance.…”

“… 3 , 6 , 18 The diagnosis of HCC was suspected if a liver mass was found on an ultrasonography or computed tomography scan with contrast enhancement and ascertained in the presence of one of the following criteria: radiological finding of portal vein thrombosis, elevation of the alpha-fetoprotein >400 ng/mL, and malignant hepatic cells found in the fine-needle aspiration cytology or histological pattern of HCC on liver biopsy examination. 3 , 6 , 16 , 17 Patients with incomplete data for establishing the diagnosis of HCC and those with secondary liver cancer, liver abscess, and benign liver tumors or liver vascular diseases were excluded.…”

“…Any specific treatments such as liver resection, transarterial chemoembolization, chemotherapy with sorafenib, and radiofrequency ablation were not feasible in all patients with HCC because of the advanced stage of the disease, lack of expertise, or medical facilities. 3 , 16 , 17 Sorafenib was not affordable for those with an intermediate-stage HCC (BCLC grade C). 6 For all patients, data were retrieved from the clinical chart at baseline and comprised the following information: age; gender; past medical history (arterial hypertension, diabetes, and positivity for human immunodeficiency virus test); clinical, radiological and endoscopic futures of the HCC (tumor size; number of nodules and their location on the liver parenchyma; and presence of ascites, encephalopathy, portal vein thrombosis, and esophageal varices); transaminases; total bilirubin;, albumin; prothrombin time; international normalized ratio; serum creatinine; hemoglobin; white blood cells; neutrophils and lymphocyte cells; platelet count; alpha-fetoprotein level; serological testing for hepatitis B, C, and D infection; alcohol intake; and the length of follow-up.…”

“… 3 These patients with advanced HCC are candidates for palliative treatment. 3 , 16 , 17 Data on the efficacy of CTP, MELD scores and BCLC staging system in predicting mortality in Black African patients with advanced HCC are scanty. 3 , 16 , 17 Furthermore, to our knowledge, there are no data on the efficacy of NLR and PLR in predicting mortality in these particular patients in Africa.…”

Sexual Dimorphism in Chronic Hepatitis B Virus (HBV) Infection: Evidence to Inform Elimination Efforts

“…In specific studies, male:female ratios for HCC are between 2:1 and 9:1. This wide variability is at least partly accounted for by the prevalence of CHB 46 , as in settings in which HBV accounts for a high prevalence of HCC, the male:female ratios are typically high 47 , for example in Senegal, where HBV accounted for almost 70% of HCC cases, the sex ratio was 6.6 48 , and in Vietnam, where >80% of HCC was HBV-associated, the ratio was 8.9:1 49 . HCC outcomes are worse when the aetiology is HBV 50 , and in males compared to females 51 .…”