Treatment of hepatocellular carcinoma in sub-Saharan Africa: challenges and solutions.

Autor:	Jonas E; Department of Surgery, University of Cape Town, Cape Town, South Africa. Electronic address: eduard.jonas@uct.ac.za., Bernon M; Department of Surgery, University of Cape Town, Cape Town, South Africa., Robertson B; Division of Radiation Oncology, Department of Radiation Medicine, University of Cape Town, Cape Town, South Africa., Kassianides C; Department of Medicine, University of Cape Town, Cape Town, South Africa., Keli E; Department of General and Digestive Surgery, Hôpital Militaire d'Abidjan, Abidjan, Côte d'Ivoire., Asare KO; Department of Surgery, Korle Bu Teaching Hospital and the University of Ghana Medical School, Accra, Ghana., Alatise IO; Department of Surgery, Obafemi Awolowo University, Obafemi Awolowo University Teaching Hospital Complex, Ile Ife, Nigeria., Okello M; Department of Surgery, Uganda Martyrs Hospital Lubaga, Kampala, Uganda., Blondel NO; Centre Hospitalier d'Essos and Department of Surgery, University of Yaoundé, Yaoundé, Cameroon., Mulehane KO; Department of Surgery, Kenyatta Hospital, Nairobi, Kenya., Abubeker ZA; Department of Surgery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia., Nogoud AA; Department of Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan., Nashidengo PR; Department of Surgery, Windhoek Central Hospital, University of Namibia School of Medicine, Windhoek, Namibia., Chihaka O; Department of Surgery, University of Zimbabwe, Harare, Zimbabwe., Tzeuton C; Faculty of Medicine and Pharmaceutical Sciences of Douala, University of Douala, Douala, Cameroon., Dusheiko G; Institute of Liver Studies, King's College Hospital, London, UK; University College London Medical School, London, UK., Sonderup M; Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa., Spearman CW; Division of Hepatology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Jazyk:	angličtina
Zdroj:	The lancet. Gastroenterology & hepatology [Lancet Gastroenterol Hepatol] 2022 Nov; Vol. 7 (11), pp. 1049-1060. Date of Electronic Publication: 2022 Jul 08.
DOI:	10.1016/S2468-1253(22)00042-5
Abstrakt:	Most patients who develop hepatocellular carcinoma reside in resource-poor countries, a category that includes most countries in sub-Saharan Africa. Age-standardised incidence rates of hepatocellular carcinoma in western, central, eastern, and southern Africa is 6·53 per 100 000 inhabitants to 11·1 per 100 000 inhabitants. In high-income countries, around 40% of patients are diagnosed at an early stage, in which interventions with curative intent or palliative interventions are possible. By contrast, 95% of patients with hepatocellular carcinoma in sub-Saharan Africa present with advanced or terminal disease. In high-income countries, targets of 30-40% that have been set for intervention with curative intent are regularly met, with expected 5-year overall survival rates in the region of 70%. These outcomes are in sharp contrast with the very small proportion of patients in sub-Saharan Africa who are treated with curative intent. Primary prevention through the eradication and reduction of risk factors is still suboptimal because of logistical challenges. The challenges facing primary prevention, in combination with difficult-to-manage historic and emerging risk factors, such as ethanol overconsumption and metabolic dysfunction-associated liver disease, mandates secondary prevention for populations at risk through screening and surveillance. Although the increased treatment needs yielded by screening and surveillance in high-income countries are manageable by the incremental expansion of existing interventional resources, the lack of resources in sub-Saharan Africa will undermine the possible benefits of secondary prevention. An estimate of the projected effect of the introduction and expansion of screening and surveillance, resulting in stage migration and possibilities for active interventions for hepatocellular carcinoma, would facilitate optimal planning and development of resources. Competing Interests: Declaration of interests CK reports a leadership or fiduciary role as chairman of the Gastroenterology Foundation of sub-Saharan Africa and the Gastroenterology and Hepatology Association of sub-Saharan Africa. IOA reports the following grants from the grants from the National Institute of Health: R01 CA246620-01A1 (National Cancer Institute. Determining the risk factor profile and biology of colorectal cancer in Nigeria); UH3 CA257869-03 (National Cancer Institute. Point of care, real-time urine metabolomics test to diagnose colorectal cancers and polyps in low and middle-income countries); R21 CA239784-01 (National Cancer Institute. Tablet-based mobile health ultrasound for point-of-care breast cancer diagnosis in Nigeria). GD reports grants from Abbott Diagnostics and Cepheid paid to his institution; in the past 2 years GD reports speaker fees from Cepheid and Clinical Care Options; is a member of safety monitoring boards for Aligos, Arbutus, Gilead Sciences, GlaxoSmithKline, and Janssen; is an advisory board member for Antios, Aligos, and Gilead Sciences; serves as an advisor to the Singapore National Medical Research Council; and is an unpaid advisor to the TherVacB Consortium and A-Tango Consortium (European Union Horizon Grants). MS reports support for attending a cancer meeting sponsored by Roche as speaker in Accra, Ghana, in October, 2021. No NIH funding and no other funding was received for the writing of this manuscript. All other authors declare no competing interests. (Copyright © 2022 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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