Abstract 2346: Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients
Authors: Bittaye Sheikh Omar , Njie Ramou , Tekanyi Muhammed , Kambi Abubacarr , Tamba Saydiba , Fatty Gibril , Bah Yusupha , Jatta Abdoulie , Sanneh Lamin , Sisawo Momodou Musa 
Published: September 2020

Abstract
INTRODUCTION: The clinical manifestations of patients with Hepatocellular carcinoma (HCC) have changed significantly in the last decades in countries that have adopted screening tests. In developing countries due to the rarity of surveillance/screening programs coupled with diagnostic challenges of HCC, most patients present late. OBJECTIVE: To evaluate the clinical manifestations, staging and prognostic factors of HCC in Gambian patients.
METHODS: Patients with suspected HCC referred to the main liver clinic at the Medical Research Council were recruited from June 2011 to September 2019. The diagnostic criteria for HCC comprised of ultrasound demonstration of liver mass greater than or equal to 2 cm combined with alpha-fetoprotein (AFP) level of greater than or equal to 200 ng/ml and/or histopathological confirmation. Clinical, radiological, fibroelastrography and laboratory data were collected in all patients. Kaplan -Meier, univariate and multivariate cox regression analyses were used to assess factors related to survival in these patients.
RESULTS: Five hundred and seventy three patients were recruited into the study. The mean age of HCC patient was 40 years and mostly males (81%). The most common constitutional symptoms were weight loss (84.1%), easy fatiguability (86.3%) while the most common gastrointestinal symptoms were early satiety (79.9%) and abdominal pain (81.8%). The most common signs were hepatomegaly (76.6%) and abdominal tenderness (48.1%). Multi-focal lesions were more common on ultrasound scan (63.4%) compared to single lesions, and the median fibroelastography score was 74 kpa in these patients. Hepatitis B surface Antigen (HBsAg) carriage was present in 69.6% of HCC patients with a median AFP of 4044 ng/ml. WHO performance status 1, BCLC stage C and Child-Pugh stage A were most common among this patient group. HBsAg-positive patients with HCC were mostly males, much younger, most likely to have jaundice, dark urine, abdominal tenderness, raised transaminases, haemoglobin and international normalised ratio (INR) levels and decreased platelet counts. HCC patients who were HBsAg-negative tended to be older, more likely to have weight loss, easy fatiguability, hypertension and had a much better median survival (42.5 days vs 35 days). Both prognostic staging systems had good stratification of survival. Independent factors that affect survival were abdominal pain, jaundice at the time of presentation, hyponatremia and hypoglycaemia.
CONCLUSIONS: HBV is a significant factor in HCC in The Gambia. Young males who are the main work-force are disproportionately affected, are more likely to be symptomatic and have much shorter survival. In resource limited countries like The Gambia where screening programmes and therapeutic interventions are limited, the prognosis and survival of patients with HCC patients is poor, emphasizing the need for early preventative strategies.
Citation Format: Sheikh Omar Bittaye, Ramou Njie, Muhammed Tekanyi, Abubacarr Kambi, Saydiba Tamba, Gibril Fatty, Yusupha Bah, Abdoulie Jatta, Lamin Sanneh, Momodou Musa Sisawo. Clinical manifestation, staging and prognosis of hepatocellular carcinoma in Gambian patients [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2346.