No Patients to Resect or Transplant: An Analysis of Patients with Hepatocellular Carcinoma Admitted to a Major African Referral Hospital

Gyedu, Adam; Shrauner, William R.; Kingham, T. Peter

doi:10.1007/s00268-014-2762-1

Cited by 14 publications

(14 citation statements)

References 23 publications

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“…Yang et al in 2017 reported that 84% of liver cancer cases presented with multinodular disease (9). In Ghana, Gyedu et al found that only 8% of persons with HCC seen at the Komfo Anokye Teaching Hospital in Accra between 2007-2013 were eligible for curative treatment (10). In our study, the AFP performed well as a diagnostic test in the detection in HCC.…”

Section: Discussionsupporting

confidence: 62%

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.

Nartey

Awuku

Agyei-Nkansah

et al. 2020

Preprint

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Background: End-stage liver disease (ESLD) is a major burden on public health, particularly in sub-Saharan Africa, where hepatitis B virus (HBV) is an important risk factor. We aimed to describe clinical characteristics of ESLD from cirrhosis or hepatocellular carcinoma (HCC) and the performance of aspartate aminotransferase (AST) - platelet ratio index (APRI) and alpha fetoprotein (AFP) in Ghana. Methods: We performed an observational cross-sectional study in outpatient hepatology clinics at three teaching hospitals in Ghana, West Africa. One hundred and forty-one HCC, 216 cirrhosis and 218 chronic HBV patients were recruited by convenience sampling. Sociodemographic, history and examination, laboratory, and disease staging information were shown using descriptive statistics. Performance of the APRI score in diagnosis of cirrhosis and AFP in the diagnosis of HCC was determined using AUROC analysis.Results: Median age at presentation was 44 years for HCC and 46 years for cirrhosis. HBV was found in 69.5% of HCC and 47.2% of cirrhosis cases, and HCV in 6.4% and 3.7% respectively. APRI cut-off of 2 had sensitivity of 45.4% and specificity of 95% in diagnosis of cirrhosis, and cut-off of 1 had sensitivity of 75.9% and specificity of 89%. AUC of AFP was 0.88 (95% CI 0.81-0.94) in diagnosis of HCC. Low monthly income was associated with lower odds of undertaking AFP. Thirty one percent of cirrhotic persons were Child-Pugh C, and 67.9% of HCC patients had advanced or terminal disease at presentation. Conclusions: Our findings emphasize the young age of ESLD patients in Ghana and the advanced nature at presentation. It highlights shortcomings in surveillance and the need for policies to address the burden and improve outcomes in Ghana.

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Section: Discussionsupporting

confidence: 62%

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.

Nartey

Awuku

Agyei-Nkansah

et al. 2020

Preprint

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“…This study confirms the important contribution of HBV to HCC in Ghana as in many other SSA countries [ 2 , 12 ]. HBsAg positivity of 71.7% is higher than 52% previously reported in 2015 from Kumasi in Ghana and 60% from The Gambia and 48% from Ethiopia, both of which also have very high population prevalence of HBV [ 9 , 11 , 15 ]. The positive aspect to this finding is that HCC in Ghana remains a largely preventable cancer if the appropriate HBV control measures like childhood vaccination as in Taiwan and access to antiviral therapy can be effectively implemented [ 16 , 17 ].…”

Section: Discussionmentioning

confidence: 72%

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

Tachi¹,

Agyei-Nkansah²,

Archampong³

2020

Pan Afr Med J

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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.

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“…These findings may be a reflection of the need for building cancer‐specific surgical capacity aimed at improving outcomes for the increasing number of cancer patients in SSA. They may also be the consequence of the often documented late‐stage presentation among cancer patients in SSA …”

Section: Discussionmentioning

confidence: 99%

“…They may also be the consequence of the often documented late-stage presentation among cancer patients in SSA. [25][26][27][28][29] Adequate staging was available for only 40% of patients who had a tissue or radiologically confirmed diagnosis of cancer. This is consistent or better than reports from other SSA countries like Uganda, The Gambia, and Malawi 11,23,30,31 ; however it is less than the 50% reported from Pakistan, another LMIC country.…”

Section: F I G U R Ementioning

confidence: 99%

Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes

Gyedu

Gaskill

Agbedinu

et al. 2018

Journal of Surgical Oncology

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No Patients to Resect or Transplant: An Analysis of Patients with Hepatocellular Carcinoma Admitted to a Major African Referral Hospital

Cited by 14 publications

References 23 publications

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.

Ambulatory end-stage liver disease in Ghana; patient profile and utility of alpha fetoprotein and aspartate aminotransferase - platelet ratio index.

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

Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes

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