Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium
Loading...
Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
The lancet Gastroenterology & hepatology
Abstract
Hepatocellular carcinoma is a leading cause of cancer-related death in Africa, but there is still no
comprehensive description of the current status of its epidemiology in Africa. We therefore initiated an African
hepatocellular carcinoma consortium aiming to describe the clinical presentation, management, and outcomes of
patients with hepatocellular carcinoma in Africa.
Methods We did a multicentre, multicountry, retrospective observational cohort study, inviting investigators from
the African Network for Gastrointestinal and Liver Diseases to participate in the consortium to develop
hepatocellular carcinoma research databases and biospecimen repositories. Participating institutions were from
Cameroon, Egypt, Ethiopia, Ghana, Ivory Coast, Nigeria, Sudan, Tanzania, and Uganda. Clinical information—
demographic characteristics, cause of disease, liver-related blood tests, tumour characteristics, treatments, last
follow-up date, and survival status—for patients diagnosed with hepatocellular carcinoma between Aug 1, 2006,
and April 1, 2016, were extracted from medical records by participating investigators. Because patients from Egypt
showed diff erences in characteristics compared with patients from the other countries, we divided patients into
two groups for analysis; Egypt versus other African countries. We undertook a multifactorial analysis using the
Cox proportional hazards model to identify factors aff ecting survival (assessed from the time of diagnosis to last
known follow-up or death).
Findings We obtained information for 2566 patients at 21 tertiary referral centres (two in Egypt, nine in Nigeria,
four in Ghana, and one each in the Ivory Coast, Cameroon, Sudan, Ethiopia, Tanzania, and Uganda). 1251 patients
were from Egypt and 1315 were from the other African countries (491 from Ghana, 363 from Nigeria, 277 from
Ivory Coast, 59 from Cameroon, 51 from Sudan, 33 from Ethiopia, 21 from Tanzania, and 20 from Uganda). The
median age at which hepatocellular carcinoma was diagnosed signifi cantly later in Egypt than the other African
countries (58 years [IQR 53–63] vs 46 years [36–58]; p<0·0001). Hepatitis C virus was the leading cause of
hepatocellular carcinoma in Egypt (1054 [84%] of 1251 patients), and hepatitis B virus was the leading cause in the
other African countries (597 [55%] of 1082 patients). Substantially fewer patients received treatment specifi cally for
hepatocellular carcinoma in the other African countries than in Egypt (43 [3%] of 1315 vs 956 [76%] of 1251;
p<0·0001). Among patients with survival information (605 [48%] of 1251 in Egypt and 583 [44%] of 1315 in other
African countries), median survival was shorter in the other African countries than in Egypt (2·5 months [95% CI
2·0–3·1] vs 10·9 months [9·6–12·0]; p<0·0001). Factors independently associated with poor survival were: being
from an African countries other than Egypt (hazard ratio [HR] 1·59 [95% CI 1·13–2·20]; p=0·01), hepatic
encephalopathy (2·81 [1·72–4·42]; p=0·0004), diameter of the largest tumour (1·07 per cm increase [1·04–1·11];
p<0·0001), log α-fetoprotein (1·10 per unit increase [1·02–1·20]; p=0·0188), Eastern Cooperative Oncology Group
performance status 3–4 (2·92 [2·13–3·93]; p<0·0001) and no treatment (1·79 [1·44–2·22]; p<0·0001).
Interpretation Characteristics of hepatocellular carcinoma diff er between Egypt and other African countries.
The proportion of patients receiving specifi c treatment in other African countries was low and their outcomes were
extremely poor. Urgent eff orts are needed to develop health policy strategies to decrease the burden of hepatocellular
carcinoma in Africa.
Description
Keywords
Characteristics, Management, Patients, Hepatocellular carcinoma, Africa, Multicountry observational study, Africa Liver Cancer Consortium
Citation
Yang, J. D., Mohamed, E. A., Aziz, A. O. A., Shousha, H. I., Hashem, M. B., Nabeel, M. M., ... & for Gastrointestinal, A. N. (2017). Characteristics, management, and outcomes of patients with hepatocellular carcinoma in Africa: a multicountry observational study from the Africa Liver Cancer Consortium. The lancet Gastroenterology & hepatology, 2(2), 103-111. http://dx.doi.org/10.1016/ S2468-1253(16)30161-3