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Abstract
Introduction. The occurrence of hepatocellular carcinoma (HCC) is closely linked to that of viral hepatitis. In Cameroon, a country with a high endemicity of viral hepatitis, HCC is the most frequent digestive cancer. Our aim was to evaluate the survival and prognostic factors of hepatocellular carcinoma in three referral hospitals in Cameroon. Methodology. This was a cross-sectional, analytic study conducted over a period from January 1, 2009 to December 31, 2016 in three referral hospitals in the cities of Douala and Yaoundé, Cameroon. All patients with hepatocellular carcinoma diagnosed histologically or by typical CT images and alpha-fetoprotein elevation above 200 ng/ml were included. Sociodemographic, clinical, paraclinical, therapeutic and evolutionary data were collected. Survival curves were obtained using the Kaplan-Meier method. Univariate and multivariate logistic regression was used to identify factors independently associated with prognosis at a significance level of p<0.05. Results. We collected 925 patient records, 357 of whom were carriers of hepatocellular carcinoma, representing a hospital frequency of 38.6%. The mean age was 51.8 ±17.5 years, with males accounting for 73.6% of cases. The main etiologies were viral hepatitis B and C in 49.9% and 47.1% respectively. Cirrhosis was present in 89.9% of cases. The main clinical signs were abdominal pain (78.2%), ascites (70.3%) and jaundice (69.2%). Alpha-fetoprotein levels were above 200 ng/ml in 54.6% of cases. Radiologically, there were more than 03 hepatic nodules in 77% of cases, larger than 3cm in 85.7%. Portal invasion was present in 35.6% of cases, and metastases in 41.5%. According to the Barcelona BCLC classification, the tumor was classified C and D in 39.5% and 28% of cases respectively. Treatment was palliative in 96.1% of cases, mainly sorafenib (58.9%). Overall survival was 8.8 months, with a 6-month survival of 23.2%. Factors associated with death were impaired general condition (OR=10.67; CI95%: 4.55 - 15.62; p<0.0001) portal invasion (OR=7.83; CI95%: 3.73 - 12.69; p=0.002), BCLC stage (OR= 3.42; IC95%: 1.48 - 5.89; 0.008) and palliative treatment (OR= 2.85; IC95%: 1.54 - 6.27; p=0.006). Conclusion. Hepatocellular carcinoma has a hospital incidence of 38.6% and an overall survival of 8.8 months. Prognostic factors include tumour stage, portal invasion and type of treatment.
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References
- Sombié R. Un drame africain : à quand la fin du carcinome hépatocellulaire ? J Afr Hépato-Gastroentérologie. 2017;11(1):1‑2.
- Li Q, Cao M, Lei L, Yang F, Li H, Yan X, et al. Burden of liver cancer: From epidemiology to prevention. Chin J Cancer Res. 12 déc 2022;34(6):554.
- Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209‑49.
- Kew MC. Epidemiology of hepatocellular carcinoma in sub-Saharan Africa. Ann Hepatol. 2013;12(2):173‑82.
- Mahamat YEB, Bwelle G, Chopkeng C, Bombah F, Tim FT, Bang GA, et al. The Epidemiological Profil of Digestive Cancers in Secondary and Tertiary Health Care Facilities in Cameroon. Surg Sci. 7 mars 2022;13(3):98‑104.
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- Noah DN, Andoulo FA, Bonny AB, Doungé BD, Eloumou SAF, Zogo PO. Prévalence du carcinome Hépatocellulaire chez les porteurs d’hépatopathie chronique à Yaoundé-Cameroun. Rev Médecine Pharm. 2016;6(1):507‑13.
- Nisha Sahu, Samrat Rakshit,, L.V.K.S. Bhaskar. Risk factors and pathogenic mechanism–associated hepatocellular carcinoma. In: Theranostics and Precision Medicine for the Management of Hepatocellular Carcinoma. Academic Press; 2022. p. 33‑49. Disponible sur: https://www.sciencedirect.com/science/article/abs/pii/B9780323988063000234
- Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 1 juill 2018;69(1):182‑236.
- Richani M, Kolly P, Knoepfli M, Herrmann E, Zweifel M, von Tengg-Kobligk H, et al. Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm. Ann Hepatol. 2016;15(1):82‑90.
- Eloumou SAFB, Bekolo Nga WT, Kenfack GU, Touko L, Malongue A, Tzeuton C, et al. Facteurs Pronostiques du Cancer Colorectal au Cameroun. Health Sci Dis [Internet]. 2020 ;21(2). Disponible sur: https://www.hsd-fmsb.org/index.php/hsd/article/view/1826
- Bossali F, Okandze LK, Katende S, Thouassa A. Séroprévalence de l’hépatite B chez les malades atteints de cirrhose et des malades porteurs du carcinome hépatocellulaire à Pointe-Noire de 2005 à 2008. J Afr Hépato-Gastroentérologie. 2011;1(5):2‑5.
- Razavi H. Global epidemiology of viral hepatitis. Gastroenterol Clin. 2020;49(2):179‑89.
- Soumaré G, Sanogo SD, Maiga A, Mallé O, Mallé M, Dembélé IA, et al. Clinical and Epidemiological Aspects of Hepatocellular Carcinoma at the Internal Medicine Department of Point “G” Teaching Hospital in Mali. Open J Gastroenterol. 2023;13(7):250‑5.
References
Sombié R. Un drame africain : à quand la fin du carcinome hépatocellulaire ? J Afr Hépato-Gastroentérologie. 2017;11(1):1‑2.
Li Q, Cao M, Lei L, Yang F, Li H, Yan X, et al. Burden of liver cancer: From epidemiology to prevention. Chin J Cancer Res. 12 déc 2022;34(6):554.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209‑49.
Kew MC. Epidemiology of hepatocellular carcinoma in sub-Saharan Africa. Ann Hepatol. 2013;12(2):173‑82.
Mahamat YEB, Bwelle G, Chopkeng C, Bombah F, Tim FT, Bang GA, et al. The Epidemiological Profil of Digestive Cancers in Secondary and Tertiary Health Care Facilities in Cameroon. Surg Sci. 7 mars 2022;13(3):98‑104.
Okonkwo U, Nwosu M, Ukah C, Okpala O, Ahaneku J. The clinical and pathological features of hepatocellular carcinoma in Nnewi, Nigeria. Niger J Med J Natl Assoc Resid Dr Niger. 2011;20(3). Disponible sur: https://pubmed.ncbi.nlm.nih.gov/21970220/
Nikièma Z, Sawadogo A, Kyelem CG, Cissé R. Carcinomes hépatocellulaires en milieu africain burkinabè: contribution de l’échographie à propos de 58 cas. Pan Afr Med J [Internet]. 2010;7. Disponible sur: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3172639/
Ankouane Andoulo F, Noah Noah D, Hell Medjo E., Kamsi Djomkam I., Ndjitoyap Ndam EC. Hepatocellular carcinoma in Cameroon: epidemiology and risk factors. J Appl Med Sci. 2014;3(2):27‑33.
Noah DN, Andoulo FA, Bonny AB, Doungé BD, Eloumou SAF, Zogo PO. Prévalence du carcinome Hépatocellulaire chez les porteurs d’hépatopathie chronique à Yaoundé-Cameroun. Rev Médecine Pharm. 2016;6(1):507‑13.
Nisha Sahu, Samrat Rakshit,, L.V.K.S. Bhaskar. Risk factors and pathogenic mechanism–associated hepatocellular carcinoma. In: Theranostics and Precision Medicine for the Management of Hepatocellular Carcinoma. Academic Press; 2022. p. 33‑49. Disponible sur: https://www.sciencedirect.com/science/article/abs/pii/B9780323988063000234
Galle PR, Forner A, Llovet JM, Mazzaferro V, Piscaglia F, Raoul JL, et al. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 1 juill 2018;69(1):182‑236.
Richani M, Kolly P, Knoepfli M, Herrmann E, Zweifel M, von Tengg-Kobligk H, et al. Treatment allocation in hepatocellular carcinoma: Assessment of the BCLC algorithm. Ann Hepatol. 2016;15(1):82‑90.
Eloumou SAFB, Bekolo Nga WT, Kenfack GU, Touko L, Malongue A, Tzeuton C, et al. Facteurs Pronostiques du Cancer Colorectal au Cameroun. Health Sci Dis [Internet]. 2020 ;21(2). Disponible sur: https://www.hsd-fmsb.org/index.php/hsd/article/view/1826
Bossali F, Okandze LK, Katende S, Thouassa A. Séroprévalence de l’hépatite B chez les malades atteints de cirrhose et des malades porteurs du carcinome hépatocellulaire à Pointe-Noire de 2005 à 2008. J Afr Hépato-Gastroentérologie. 2011;1(5):2‑5.
Razavi H. Global epidemiology of viral hepatitis. Gastroenterol Clin. 2020;49(2):179‑89.
Soumaré G, Sanogo SD, Maiga A, Mallé O, Mallé M, Dembélé IA, et al. Clinical and Epidemiological Aspects of Hepatocellular Carcinoma at the Internal Medicine Department of Point “G” Teaching Hospital in Mali. Open J Gastroenterol. 2023;13(7):250‑5.