title: No patients to resect or transplant: an analysis of patients with hepatocellular carcinoma admitted to a major African referral hospital.
abstract: BACKGROUND
  This study aimed to describe the characteristics of patients diagnosed with hepatocellular carcinoma (HCC) at the Komfo Anokye Teaching Hospital (KATH) in Ghana and to determine their treatment options per the Barcelona Clinic Liver Cancer (BCLC) algorithm.
  
  
  METHODS
  We reviewed the medical records of patients diagnosed with HCC at KATH in the period 2007-2013. Patient demographics, medical history, investigations, management, and outcome were extracted. BCLC staging was applied to determine their treatment options. Results were expressed as descriptive statistics.
  
  
  RESULTS
  The charts for 206/465 patients were available for review. The male:female ratio was 2:1 and mean age was 44.0 ± 14.5 years. Common presenting complaints were abdominal distension, abdominal pain, and jaundice. hepatitis B virus (HBV) positivity was 52 %. Almost all patients received only supportive treatment. None underwent surgery, ablation, or transarterial chemoembolization. BCLC staging could be completed for 118 patients. Using predicted INR values in cases without the result, < 8 % of patients were eligible for resection, transplantation, or ablation; 25-53 % were eligible for embolization or sorafenib therapy. Up to 72 % were eligible only for supportive care. Seventy-six percent of patients reviewed were discharged alive; 71 % of patients whose charts were not available died during an admission. Thus, of the 465-patient cohort, 50 % died in the hospital.
  
  
  CONCLUSIONS
  The majority of HCC in our population is caused by HBV. Up to 61 % of patients may be eligible for curative treatment, transarterial chemoembolization, or sorafenib treatment. This percentage may be increased with a robust surveillance program for patients at increased risk for HCC. Hepatitis B vaccination must also be a public health priority.
authors.affiliation: Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Private Mailbag, University Post Office, Kumasi, Ghana, drgyedu@gmail.com.
authors.forename: Adam
authors.initials: A
authors.lastname: Gyedu
authors.forename: William R
authors.initials: WR
authors.lastname: Shrauner
authors.forename: T Peter
authors.initials: TP
authors.lastname: Kingham
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000821:virology; D017115:Catheter Ablation / Q000706:statistics & numerical data; D004322:Drainage / Q000706:statistics & numerical data; D004621:Embolization, Therapeutic / Q000706:statistics & numerical data; D005260:Female; D005869:Ghana / Q000453:epidemiology; D019694:Hepatitis B, Chronic / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000821:virology; D008297:Male; D009367:Neoplasm Staging