A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania
Main Article Content
Keywords
epidemiology, hepatocellular carcinoma, liver cancer, liver resection, liver transplantation, Tanzania
Abstract
Hepatocellular carcinoma (HCC) is one of the commonest causes of cancer-related morbidity and mortality worldwide. However, only a limited number of studies on HCC have been conducted in Tanzania. We therefore conducted a cross-sectional study among in-patients treated for HCC in a tertiary referral hospital located in Dar es Salaam, Tanzania, in order to provide a concise description of the clinical characteristics and treatment options offered in the study setting. We identified 36 in-patients treated for HCC over a 6-month data collection period. Seventy-seven percent (n = 28) of the participants were males and about two-thirds (61.2%) were aged between 40 and 60 years. Majority (44.4% [n = 16]) of the patients had Child-Pugh class B and an Eastern Cooperative Oncology Group (ECOG) performance status of 2 (33.3% [n = 12]). Patients with tumors >6.5 cm and multinodular tumors (>3 nodules) accounted for 69.4% (n = 25) and 55.6% (n = 20), respectively. Portal vascular invasion and extrahepatic metastasis were respectively present in 27.8% (n = 10) and 25% (n = 9) of the patients. Of the study participants, only two had early-stage disease as per the Barcelona Clinic Liver Cancer (BCLC) staging system, corresponding to the observed tumor resection rate of 5.6%. The most frequently reported inoperable factor among the study participants was an ECOG performance status > 0 (n = 30 [83.3%]). Findings thus reveal a high proportion of late-stage diseases among participants that could have resulted in the observed low tumor resection rate. Initiatives to facilitate identification of the disease at an early stage are therefore paramount in optimizing care.
References
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21. Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111(4):1018–1022. 10.1016/S0016-5085(96)70070-7
22. Citterio D, Facciorusso A, Sposito C, Rota R, Bhoori S, Mazzaferro V. Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg. 2016;151(9):846–853. 10.1001/jamasurg.2016.1121
23. Madkhali AA, Fadel ZT, Aljiffry MM, Hassanain MM. Surgical treatment for hepatocellular carcinoma. Saudi J Gastroenterol. 2015;21(1):11–17. 10.4103/1319-3767.151216
24. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301–1314. 10.1016/S0140-6736(18)30010-2
25. Hassan-Kadle MA, Osman MM, Keles E, Eker HH, Baydili KN, Ahmed HM, et al. Clinical characteristics of patients with hepatocellular carcinoma: a single-center 3-year experience from Somalia. Int J Hepatol. 2022;2022:3370992. 10.1155/2022/3370992
26. James GO, Parks Rowan W, Garden OJ, Parks Rowan W. Principles and practice of surgery. 7th ed. Edinburgh: Elsevier; 2018, 213 p.
27. Liu C-L. Hepatic resection for bilobar hepatocellular carcinoma. Arch Surg [Internet]. 2003;138(1):100. Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.138.1.100
28. Sotiropoulos GC, Lang H, Frilling A, Molmenti EP, Paul A, Nadalin S, et al. Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature. Hepatogastroenterology [Internet]. 53(69):322–329. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16795964
2. Petrick JL, Florio AA, Znaor A, Ruggieri D, Laversanne M, Alvarez CS, et al. International trends in hepatocellular carcinoma incidence, 1978–2012. Int J Cancer [Internet]. 2020;147(2):317–330. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ijc.32723
3. McGlynn KA, Petrick JL, London WT. Global epidemiology of hepatocellular carcinoma. Clin Liver Dis [Internet]. 2015;19(2):223–238. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1089326115000021
4. Kew MC. Epidemiology of hepatocellular carcinoma in sub-Saharan Africa. Ann Hepatol [Internet]. 12(2):173–182. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23396727
5. Tsoulfas G, Curley SA, Abdalla EK, Barnett CC, Hertl M. Liver transplantation for hepatocellular carcinoma – UpToDate [Internet]. 2022 [cited 2022 Oct 25]. Available from: https://www.uptodate.com/contents/liver-transplantation-for-hepatocellular-carcinoma
6. Jaka H, Mshana SE, Rambau PF, Masalu N, Chalya PL, Kalluvya SE. Hepatocellular carcinoma: clinicopathological profile and challenges of management in a resource-limited setting. World J Surg Oncol. 2014;12(1):1–9. 10.1186/1477-7819-12-246
7. Hiza PR. Epidemiological study of carcinoma of liver in Dodoma Region in Tanzania. J Natl Med Assoc [Internet]. 1979 [cited 2022 Oct 25];71(6):585. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2537314/
8. Petrick JL, Braunlin M, Laversanne M, Valery PC, Bray F, McGlynn KA. International trends in liver cancer incidence, overall and by histologic subtype, 1978–2007. Int J Cancer [Internet]. 2016;139(7):1534–1545. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ijc.30211
9. Wands J. Hepatocellular carcinoma and sex. N Engl J Med [Internet]. 2007;357(19):1974–1976. Available from: http://www.nejm.org/doi/abs/10.1056/NEJMcibr075652
10. Li Y, Li H, Spitsbergen JM, Gong Z. Males develop faster and more severe hepatocellular carcinoma than females in krasV12 transgenic zebrafish. Sci Rep [Internet]. 2017 [cited 2022 Nov 2];7(1):1–10. Available from: https://www.nature.com/articles/srep41280
11. Manieri E, Herrera-Melle L, Mora A, Tomás-Loba A, Leiva-Vega L, Fernández DI, et al. Adiponectin accounts for gender differences in hepatocellular carcinoma incidence. J Exp Med [Internet]. 2019 [cited 2022 Nov 3];216(5):1108–1119. Available from: 10.1084/jem.20181288
12. Wang TE, Chang CW, Liu CY, Chen MJ, Chu CH, Lin SC, et al. Clinical characteristics of hepatocellular carcinoma in elderly patients. Int J Gerontol. 2013;7(2):85–89. 10.1016/j.ijge.2013.03.003
13. Fox RK. Core concepts – surveillance for hepatocellular carcinoma – evaluation, staging, and monitoring of chronic hepatitis C – hepatitis C online [Internet]. 2018 [cited 2022 Nov 4]. Available from: https://www.hepatitisc.uw.edu/go/evaluation-staging-monitoring/surveillance-hepatocellular-carcinoma/core-concept/all
14. Brunot A, Le Sourd S, Pracht M, Edeline J. Hepatocellular carcinoma in elderly patients: challenges and solutions. J Hepatocell Carcinoma [Internet]. 2016;9. Available from: https://www.dovepress.com/hepatocellular-carcinoma-in-elderly-patients-challenges-and-solutions-peer-reviewed-article-JHC
15. Li Y, Zhang Z, Shi J, Jin L, Wang L, Xu D, et al. Risk factors for naturally-occurring early-onset hepatocellular carcinoma in patients with HBV-associated liver cirrhosis in China. Int J Clin Exp Med [Internet]. 2015;8(1):1205–1212. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25785114
16. Zaman SN, Johnson RD, Johnson PJ, Melia WM, Portmann BC, Williams R. Risk factors in development of hepatocellular carcinoma in cirrhosis: prospective study of 613 patients. Lancet (London, England) [Internet]. 1985 [cited 2022 Nov 4];1(8442):1357–1360. Available from: https://pubmed.ncbi.nlm.nih.gov/2861313/
17. Tarao K, Nozaki A, Ikeda T, Sato A, Komatsu H, Komatsu T, et al. Real impact of liver cirrhosis on the development of hepatocellular carcinoma in various liver diseases—meta-analytic assessment. Cancer Med [Internet]. 2019 [cited 2022 Nov 4];8(3):1054. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6434205/
18. Kudo M, Zheng RQ, Kim SR, Okabe Y, Osaki Y, Iijima H, et al. Diagnostic accuracy of imaging for liver cirrhosis compared to histologically proven liver cirrhosis. A multicenter collaborative study. Intervirology [Internet]. 2008 [cited 2022 Nov 4];51 (Suppl. 1):17–26. Available from: https://pubmed.ncbi.nlm.nih.gov/18544944/
19. Harris R, Card TR, Delahooke T, Aithal GP, Aithal GP, Guha IN, et al. Obesity is the most common risk factor for chronic liver disease: results from a risk stratification pathway using transient elastography. Am J Gastroenterol [Internet]. 2019 [cited 2022 Nov 6];114(11):1744–1752. Available from: https://pubmed.ncbi.nlm.nih.gov/31453812/
20. Belli A, Cioffi L, Russo G, Belli G. Liver resection for hepatocellular carcinoma in patients with portal hypertension: the role of laparoscopy. Hepatobiliary Surg Nutr. 2015;4(6):417–421.
21. Bruix J, Castells A, Bosch J, Feu F, Fuster J, Garcia-Pagan JC, et al. Surgical resection of hepatocellular carcinoma in cirrhotic patients: prognostic value of preoperative portal pressure. Gastroenterology. 1996;111(4):1018–1022. 10.1016/S0016-5085(96)70070-7
22. Citterio D, Facciorusso A, Sposito C, Rota R, Bhoori S, Mazzaferro V. Hierarchic interaction of factors associated with liver decompensation after resection for hepatocellular carcinoma. JAMA Surg. 2016;151(9):846–853. 10.1001/jamasurg.2016.1121
23. Madkhali AA, Fadel ZT, Aljiffry MM, Hassanain MM. Surgical treatment for hepatocellular carcinoma. Saudi J Gastroenterol. 2015;21(1):11–17. 10.4103/1319-3767.151216
24. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. Lancet. 2018;391(10127):1301–1314. 10.1016/S0140-6736(18)30010-2
25. Hassan-Kadle MA, Osman MM, Keles E, Eker HH, Baydili KN, Ahmed HM, et al. Clinical characteristics of patients with hepatocellular carcinoma: a single-center 3-year experience from Somalia. Int J Hepatol. 2022;2022:3370992. 10.1155/2022/3370992
26. James GO, Parks Rowan W, Garden OJ, Parks Rowan W. Principles and practice of surgery. 7th ed. Edinburgh: Elsevier; 2018, 213 p.
27. Liu C-L. Hepatic resection for bilobar hepatocellular carcinoma. Arch Surg [Internet]. 2003;138(1):100. Available from: http://archsurg.jamanetwork.com/article.aspx?doi=10.1001/archsurg.138.1.100
28. Sotiropoulos GC, Lang H, Frilling A, Molmenti EP, Paul A, Nadalin S, et al. Resectability of hepatocellular carcinoma: evaluation of 333 consecutive cases at a single hepatobiliary specialty center and systematic review of the literature. Hepatogastroenterology [Internet]. 53(69):322–329. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16795964
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Mar 11, 2023
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A Comprehensive Overview of In-patients Treated for Hepatocellular Carcinoma at a Tertiary Care Facility in Tanzania. (2023). Journal of Renal and Hepatic Disorders, 7(1), 22-27. https://doi.org/10.15586/jrenhep.v7i1.153
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