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

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 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. Results: We report 46 HCC cases with a median age of 54 years (IQR 45–62) and 50% female. Viral hepatitis was the most common underlying etiology, with 41% of subjects infected with hepatitis B virus (HBV) and 45% with hepatitis C. The median MELD was 12 (IQR 8–17), we found no association between survival and a MELD score 15, regardless of underlying disease (pr=0.61, p>0.05). 31% 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) was utilized in 16% (median survival of 352 days, IQR 30–436). HBV cases were diagnosed younger (31% before the age of 40) and those on Tenofovir had a longer median survival than those off Tenofovir (121 vs 34 days). Conclusion: Our study found that antiviral treatment of HBV infection was associated with longer survival in HCC. Furthermore, Sorafenib seemed beneficial in patients that used this modality and NLR was a good prognostic factor.