Amir Sultan, MD1, Marilia Campos, MD2, Zerihun Wondifraw, MS3, Grace Braimoh, MD4, Abate Bane, MD3, Jose D. Debes, MD5
1Addis Ababa University, Adis Ababa, Adis Abeba, Ethiopia; 2Hennepin County Medical Center, Minneapolis, MN; 3Addis Ababa University, Addis Ababa, Adis Abeba, Ethiopia; 4Hennepin Healthcare, Minneapolis, MN; 5University of Minnesota, Minneapolis, MN
Introduction: Sub-Saharan Africa exposes one of the largest burdens of morbidity and mortality from Hepatocellular carcinoma (HCC). However, there is little information about HCC presentation and outcomes form the region. In this study we describe clinical characteristics and therapeutic approach to HCC in a single center in Ethiopia.
Methods: We retrospectively evaluated clinical charts of individuals that presented with HCC at a major referral clinic in Addis Ababa, Ethiopia from 2016 to 2018. Diagnosis of HCC was performed via biopsy or imaging criteria as established by AASLD guidelines. Survival was determined as date of last visit, and calculated in days from initial diagnosis visit. Those individuals with initial and last visit of less than seven days were removed from survival analysis. Mann-Whitney test was used for survival assessment.
Results: Forty-six cases are reported. The median age was 54 years (IQR 45-62) and 50% were females. Forty-one percent of individuals had hepatitis B (HBV) as underlying liver disease, 45% had hepatitis C (HCV) and the rest were classified as “other”. There was no association between region of origin and HBV-related HCC. Seventy-eight percent (N:36) of cases had evidence cirrhosis on presentation. Median age of HCC diagnosis was 54 years (IQR 45-62) in all patients and 48 years (IQR 19-38) in those infected with HBV. Median tumor size was 6.5cm (IQR 4.5-6.9) and median MELD score was 12 (IQR 8-17). The median survival in the entire cohort was 68 days (IQR 17-334). The most common treatment modalities were trans-arterial chemoembolization (TACE, 16%), Sorafenib (18%) and Palliative care (31%), with median survival being 351, 94 and 27 days, respectively. There was no correlation between MELD score and survival at 6 months. Twenty percent of all individuals were treated with sorafenib (N:9). Median survival in this group was 92 days (IQR 24-121), despite almost all of them having AFP >400ng/ml. Interestingly, a neutrophil-to-lymphocyte ratio (NLR) of < 2.5 correlated with better survival (109 days vs 68 days for those with NLR >2.5, p=0.01).
Discussion: We found younger diagnosis of HCC in individuals infected with HBV. The great majority of patients received non-curative therapy. A small sub-group of individuals showed a reasonable survival benefit with sorafenib.
Citation: Amir Sultan, MD; Marilia Campos, MD; Zerihun Wondifraw, MS; Grace Braimoh, MD; Abate Bane, MD; Jose D. Debes, MD. P2440 - LIVER CANCER IN ETHIOPIA: PRESENTATION, PROGNOSIS, AND THERAPY. Program No. P2440. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.