Clinical Profile and Hepatocellular Cancer Treatment Patterns in Resource Limited Settings a prospective cross sectional study at Two Tertiary Referral Teaching Hospitals, Ethiopia
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Date
2025-07
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Addis Ababa University
Abstract
Background: Hepatocellular carcinoma (HCC) exerts a substantial global burden, significantly contributing to worldwide mortality, morbidity, economic costs, and hospitalization rates. A significant treatment gap exists in low and middle income countries (LMICs), characterized by a low rate of curative surgical interventions for HCC, making access to effective surgical care for this disease one of the most inequitable aspects of healthcare globally.
Objective: To assess the etiological and treatment patterns of Hepatocellular Carcinoma (HCC) in patients visited to Tikur Anbessa Specialized Hospital (TASH) and St. Paul's Hospital Millennium Medical College (SPHMMC) in Addis Ababa, Ethiopia in 2025.
Methods: A cross sectional, hospital based prospective study was conducted to investigate the etiological and treatment patterns of Hepatocellular Carcinoma (HCC). The study included a sample size of 130 HCC patients. To ensure appropriate statistical analysis, the normality of continuous variables was assessed using the Shapiro Wilk test. Normally distributed data were described using means and standard deviations, while medians and interquartile ranges were used to summarize skewed data.
Results: Our analysis of 130 Hepatocellular Carcinoma (HCC) patients requiring surgical intervention, Loco regional, systemic therapy, or supportive care revealed a mean age of 54.5 ± 16.5 years, with a slight male predominance (82/130, 63.1%). A significant proportion of participants (62/130, 47.7%) had a history of hepatitis infection while unidentified risk factor for HCC was alarmingly high (48/130, 37%). Among those with hepatitis, the majority were infected with Hepatitis B Virus (HBV) (45/62, 72.6%), while a smaller proportion had Hepatitis C Virus (HCV) (14/62, 22.6%). The majority of HCC cases presented as either multinodular/multifocal (58/130, 44.6%) or single/solitary (57/130, 44.5%) lesions, with a mean size of 10.0± 4.6cm.In those with imaging features of cirrhosis (58/130), vast majority (29/58, 50%) exhibited Child
Pugh score B. However, a large proportion of patients in our study presented with advanced
stage disease, as evidenced by the Barcelona Clinic Liver Cancer (BCLC) staging system: BCLC stage C was observed in 83 participants (63.8%). Curative Liver resection was performed in only 23 participants (17.7%), while Transarterial Chemoembolization (TACE) was utilized in 27.7% of cases.
Conclusion: Despite advancements in the surgical management of Hepatocellular Carcinoma (HCC), there remain notable challenges in providing access to curative treatments such as liver resection, transplantation, and Radiofrequency Ablation (RFA). These limitations are primarily attributable to deficiencies in highly trained human resource, inadequate infrastructure, and policy gaps, which hinder the effective delivery of potentially life saving interventions.
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Hepatocellular carcinoma