title: Hepatocellular carcinoma: clinicopathological profile and challenges of management in a resource-limited setting.
abstract: BACKGROUND
  Hepatocellular carcinoma is one of the most common cancers worldwide and its incidence is reported to be increasing in resource-limited countries. There is a paucity of published data regarding hepatocellular carcinoma in Tanzania, and the study area in particular. This study describes the clinicopathological profile of hepatocellular carcinoma in our local setting and highlights the challenging problems in the management of this disease.
  
  
  METHODS
  This was a retrospective study of histopathologically confirmed cases of hepatocellular carcinoma seen at Bugando Medical Center between March 2009 and February 2013.
  
  
  RESULTS
  A total of 142 patients (M: F = 2.2: 1) were studied representing 4.6% of all malignancies. The median age of patients was 45 years. Hepatitis B virus infection (66.2%) and heavy alcohol consumption (60.6%) were the most frequently identified risk factors for hepatocellular carcinoma. The majority of patients (88.0%) presented late with advanced stages. HBsAg was positive in 66.2% of the patients and Hepatitis C Virus antibody in 16.9%. Thirteen (9.2%) patients tested positive for HIV infection. Most patients (52.8%) had both right and left lobe involvement. The trabecular pattern (47.9%) was the most frequent histopathological type. None of patients had curative therapy because of the advanced nature of the disease. Coagulopathy (45.7%) was the most common complications. The overall mortality rate was 46.5% and it was significantly associated with comorbidity, HIV positivity, CD4+ count <200 cells/μl, high histological grade, advanced stage of the tumor, presence of distant metastases at the time of diagnosis, and associated complications (P < 0.001). The overall median duration of hospital stay was 14 days. The majority of patients (71.1%) were lost to follow-up at the end of the follow-up period.
  
  
  CONCLUSIONS
  Hepatocellular carcinoma patients in this region are relatively young at diagnosis and the majority of them present late with an advanced stage and high rate of distant metastasis. Lack of awareness of the disease, poor accessibility to healthcare facilities, and lack of screening programs in this region may contribute to advanced disease at the time of diagnosis. There is a need for early detection, adequate treatment, and proper follow-up to improve treatment outcome.
authors.forename: Hyasinta
authors.initials: H
authors.lastname: Jaka
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Mshana
authors.forename: Peter F
authors.initials: PF
authors.lastname: Rambau
authors.forename: Nestory
authors.initials: N
authors.lastname: Masalu
authors.affiliation: Department of Surgery, Catholic University of Health and Allied Sciences- Bugando, Bugando, P,O, Box 1464, Mwanza, Tanzania. drphillipoleo@yahoo.com.
authors.forename: Phillipo L
authors.initials: PL
authors.lastname: Chalya
authors.forename: Samuel E
authors.initials: SE
authors.lastname: Kalluvya
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000191:economics* / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D003131:Combined Modality Therapy; D003906:Developing Countries; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006295:Health Resources / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008113:Liver Neoplasms / Q000191:economics* / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult
references.citation: Lancet. 1981 Nov 21;2(8256):1129-33
references.pmid: 6118576
references.citation: Am J Gastroenterol. 1991 Mar;86(3):335-8
references.pmid: 1847790
references.citation: Cancer. 1995 Aug 15;76(4):579-88
references.pmid: 8625150
references.citation: Best Pract Res Clin Gastroenterol. 2005 Feb;19(1):3-23
references.pmid: 15757802
references.citation: Lancet. 1989 Oct 28;2(8670):1004-6
references.pmid: 2572739
references.citation: Br J Cancer. 1985 May;51(5):713-26
references.pmid: 2986667
references.citation: BMC Infect Dis. 2009 Feb 18;9:19
references.pmid: 19226452
references.citation: Cancer. 1991 Jan 15;67(2):429-33
references.pmid: 1845946
references.citation: Afr J Med Med Sci. 1990 Sep;19(3):191-4
references.pmid: 2120919
references.citation: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references.pmid: 15761078
references.citation: Hepatology. 1999 Jun;29(6):1704-7
references.pmid: 10347111
references.citation: East Mediterr Health J. 2012 Jul;18(7):693-9
references.pmid: 22891515
references.citation: Cent Afr J Med. 1992 Jan;38(1):25-30
references.pmid: 1321687
references.citation: Indian J Med Paediatr Oncol. 2012 Oct;33(4):221-3
references.pmid: 23580823
references.citation: Cancer. 1985 Aug 15;56(4):918-28
references.pmid: 2990661
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S27-34
references.pmid: 15508094
references.citation: Hepatology. 1998 May;27(5):1394-402
references.pmid: 9581697
references.citation: J Gastroenterol Hepatol. 2007 Jul;22(7):1104-11
references.pmid: 17559381
references.citation: J Hepatol. 1998 Dec;29(6):944-52
references.pmid: 9875641
references.citation: Hepatology. 2003 Dec;38(6):1393-400
references.pmid: 14647050
references.citation: J Natl Cancer Inst. 2000 Jan 19;92(2):148-53
references.pmid: 10639517
references.citation: Hepatology. 1992 May;15(5):948-63
references.pmid: 1314774
references.citation: World J Gastroenterol. 2005 Sep 7;11(33):5193-8
references.pmid: 16127751
references.citation: Ann Hepatol. 2013 Mar-Apr;12(2):173-82
references.pmid: 23396727
references.citation: J Hepatol. 2008;48 Suppl 1:S20-37
references.pmid: 18304676
references.citation: J Viral Hepat. 1994;1(1):17-31
references.pmid: 8790556
references.citation: East Afr Med J. 1977 May;54(5):281-92
references.pmid: 71984
references.citation: J Clin Oncol. 2009 Mar 20;27(9):1485-91
references.pmid: 19224838
references.citation: N Engl J Med. 2007 Nov 8;357(19):1974-6
references.pmid: 17989393
references.citation: Ann Afr Med. 2007 Jun;6(2):54-7
references.pmid: 18240703
references.citation: Science. 2007 Jul 6;317(5834):121-4
references.pmid: 17615358
references.citation: Niger J Med. 2001 Apr-Jun;10(2):59-63
references.pmid: 11705059
references.citation: Turk J Gastroenterol. 2003 Jun;14(2):85-90
references.pmid: 14614632