Hepatocellular carcinoma in Ghana: a retrospective analysis of a tertiary hospital data

Abstract

Introduction Hepatocellular carcinoma (HCC) is a cancer of global public health concern because of its high incidence and mortality. The impact is greatest in areas with high prevalence of its major risk factors including chronic hepatitis B virus (HBV). HBV is endemic in Ghana but a comprehensive data on HCC is lacking. The aim of this study was to describe the clinical, laboratory and radiological features of HCC at the Korle Bu Teaching Hospital in Ghana. Methods The medical records of 194 HCC cases attended to at the Gastrointestinal Clinic of the Korle Bu Teaching Hospital between January 2015 and December 2018 were retrospectively analyzed for demographic, clinical, laboratory and radiological data. Results The male: female ratio was 2:1 and mean age was 45.2 years. Weight loss and abdominal pain were the major presenting symptoms. No patients were identified through surveillance. HBsAg was positive in 109/145 (75.2%) of cases tested. Sixty-five (59.6%) of 109 HBsAg positives were aware of their HBsAg status but only 3 were receiving medical follow ups prior to the diagnosis of HCC. Raised alpha-fetoprotein level >165.2 IU/ML was found in 53.9%. One hundred and forty-four patients were eligible for only analgesia. Conclusion HBV infection is the leading aetiologial risk factor associated with HCC. Majority of HBV carriers are aware of their status but do not receive care prior to HCC diagnosis. Majority present late and are eligible for only palliative treatment. Improvement in the health seeking behavior of HBV carriers can aid early detection of HCC.

Clinical Characteristics of Patients with Hepatocellular Carcinoma: A Single-Center 3-Year Experience from Somalia

“…The predominance of males lent support to previous findings [ 14 ]. Our results are in line with studies reported from countries in the region, such as Ghana [ 15 ] and Egypt [ 16 ], where male domination was reported. The male predominance demonstrated in these studies was explained by the higher susceptibility of males to environmental carcinogens and greater exposure to environmental risk factors compared to the female population [ 16 ].…”

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.…”