Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients

Sheikh Omar Bittaye; Abubacarr Kambi; Momodou A I Tekanyi; Saydiba Tamba; Lamin Sanneh; Momodou Musa Sisawo; Abdoulie Jatta; Gibril Fatty; Adam Jeng; Momodou Salieu Jallow; Ousman Leigh; Ramou Njie

doi:10.1186/s12876-023-02952-8

Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients

BMC Gastroenterol. 2023 Sep 20;23(1):321. doi: 10.1186/s12876-023-02952-8.

Authors

Sheikh Omar Bittaye^{1

2}, Abubacarr Kambi³, Momodou A I Tekanyi³, Saydiba Tamba³, Lamin Sanneh⁴, Momodou Musa Sisawo⁴, Abdoulie Jatta⁴, Gibril Fatty⁴, Adam Jeng⁴, Momodou Salieu Jallow^{5

6}, Ousman Leigh^{5

6

7}, Ramou Njie^{3

5}

Affiliations

¹ Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia. sobittaye@utg.edu.gm.
² School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia. sobittaye@utg.edu.gm.
³ Department of Internal Medicine, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
⁴ Disease Control & Elimination, MRC Unit The Gambia @ London School of Hygiene & Tropical Medicine, Fajara, The Gambia.
⁵ School of Medicine and Allied Health Sciences, University of The Gambia, Banjul, The Gambia.
⁶ Pathology Department, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
⁷ American International University, Serekunda, Gambia.

Abstract

Background: As a result of the lack of screening programs and the difficulty in making a proper diagnosis, the majority of hepatocellular carcinoma (HHC) patients present late in low-resource countries. The study therefore assesses the clinical features, stage and prognostic variables of patients with HCC in The Gambia.

Methods: From December 2015 to January 2019, patients with a confirmed diagnosis of HCC were enrolled. All patients' medical history, ultrasound scan, FibroScan and laboratory details were collected.

Results: Two hundred and sixty (260) patients were enrolled. The mean age of HCC patients was 40 years, and 210 (80.7%) of them were male. The most common gastrointestinal symptoms were early satiety 229 (88.1%) and abdominal pain 288 (87.7%), while the most common constitutional symptoms were weight loss 237 (91.2%) and easy fatiguability 237 (91.2%). Hepatomegaly 205 (78.8%) was the most common sign. On ultrasound scan, lesions were mostly multifocal 175 (67.3%), and the median FibroScan score was 75 kPa. The median fibrosis 4 and aspartate transferase platelet ratio index were 4.6 and 2.2, respectively. Hepatitis B surface antigen (HBsAg) was positive in 170 (65.4%) patients, and the median AFP level was 3263 ng/ml. HCC patients with positive HBsAg were more likely to be male 145 (85.3%) vs 62 (72.1%) (p = 0.011), much younger 39.9 vs 51.4 yrs (p = < 0.0001), more likely to have abdominal pain 156 (91.8%) vs 68 (79.1%) (p = 0.002), jaundice 78 (45.9%) vs 29 (33.7%) (p = 0.042), dark urine 117 (68.8%) vs 46 (53.5%) (p = 0.018), raised transaminases (Aspartate transaminases 224.5 (32-7886) vs 153 (18-610), p = < 0.01, Alanine transferases 71 (5-937) vs 47 (8-271), p = < 0.001) and decreased platelet count 207 (33-941) vs 252 (52- 641) (p = 0.021) compared to patients with HCC who were HBsAg-negative.

Conclusions: The prognosis of patients with HCC is poor in developing countries such as The Gambia, where screening programs and treatment modalities are scarce. Young males are disproportionately affected, and HBV is a major cause of HCC in The Gambia.

Keywords: Carcinoma; Hepatitis B; Hepatocellular; Survival.

MeSH terms

Abdominal Pain
Adult
Aspartic Acid
Carcinoma, Hepatocellular* / diagnostic imaging
Female
Gambia
Hepatitis B Surface Antigens
Humans
Liver Neoplasms* / diagnosis
Male
Prognosis

Substances

Aspartic Acid
Hepatitis B Surface Antigens