Single center analysis of therapy and outcomes of hepatocellular carcinoma in Sub-Saharan Africa

Abstract

Purpose: To evaluate the characteristics and response to therapy for HCC in sub-Saharan Africa. Patients and methods:We retrospectively evaluated demographic, clinical and outcome variables of individuals diagnosed with HCC in a referral clinic in Ethiopia from 2016 to 2018. Survival assessment was performed using the Mann-Whitney test. Associations between categorical variables was assessed using Pearson Chi-square test. A P-value ≤ 0.05 determined statistical significance.Results: Forty-six HCC cases were reported, with a median age of 54 years (IQR 45 -62) and half of them being female. Viral hepatitis was the most common underlying etiology of liver disease, with 41% of subjects infected with hepatitis B virus (HBV) and 45% with hepatitis C. The median MELD was 12 (IQR 8-17) and we found no association between survival and a MELD score </> 15, regardless of underlying disease (pr=0.61, p>0.05). Thirty-one percent of individuals underwent supportive treatment with a median survival of 27 days (IQR 19-181), 18% used Sorafenib (median survival of 94 days, IQR 24-121), and trans-arterial chemoembolization (TACE) with curative intent was utilized in 16% (median survival of 352 days, IQR 30-436). In those treated with sorafenib, a neutrophil-to-lymphocyte ratio (NLR) of <2.5 correlated with better survival (109 vs 68 days for NLR >2.5, p=0.01). HBV cases were diagnosed younger (31% before

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

“…The overall median survival of our patients was 33 days. This is very poor when compared to other studies [ 11 , 34 – 37 ] but was similar to HCC patients who received supportive treatment only in Ethiopia [ 38 ]. Even among African countries, the overall median survival of HCC patients in Egypt was significantly longer when compared with other African countries [ 37 ].…”

A Case of Infiltrative Hepatocellular Carcinoma With Vascular Invasion Into the Heart

“…Furthermore, invasive HCC diagnosed in his 50s suggests an early onset of disease. This, though perturbing, is not uncommon in the region as recent studies from our group in Sub-Saharan Africa have documented development of HCC in patients less than 40 years of age in almost 40% of reported cases [ 4 , 10 ]. This is likely contributed by the presence of aflatoxin exposure, which in individuals with HBV infection can lead to mutation of the TP53 genes and subsequent early tumor development [ 4 ].…”

Understanding immune perspectives and options for the use of checkpoint immunotherapy in HCC post liver transplant

“…Sorafenib was the first agent to demonstrate survival benefit as a first-line therapy for unresectable HCC based on the SHARP and Asian-Pacific trials and remained the sole resource for advanced HCC for over ten years [17,18] . Sorafenib is a multi-kinase inhibitor that acts by inhibiting a variety of tyrosine-kinase receptors, including vascular endothelial growth factor receptor and platelet-derived growth factor receptor and has mainly been shown to be effective in selected patients such as those with hepatitis C and favorable neutrocyte-lymphocyte ratio [19][20][21] . Additional therapies such as lenvatinib, regorafenib, and cabozantinib, all targeting a combination of tyrosine kinase receptors, as well as ramicirumab with specific targeting of VEGF, have been approved for the treatment of HCC [22][23][24][25] .…”