Abstract
Background: Hepatocellular carcinoma (HCC) is a significant cause of cancer-related deaths worldwide, with sub-Saharan Africa, including Tanzania, experiencing a substantial burden of the disease. In northern Tanzania, HCC poses a considerable challenge due to the high prevalence of hepatitis B and C, combined with limited healthcare resources. However, there is limited knowledge about its impact in the region due to the scarcity of data. This study investigates the clinicodemographic profile, clinical presentation, treatment offered, and outcomes of patients diagnosed with HCC at a zonal hospital in northern Tanzania, aiming to support healthcare strategies for improved management and prevention of liver cancer.
Patients and Methods: We reviewed the data of patients aged 18 years or older who presented to KCMC with a diagnosis of HCC from January 1, 2016, to December 31, 2023. Diagnosis was established using American College of Radiology guidelines, incorporating triphasic CT or MRI findings and the Liver Imaging Reporting and Data System (LI-RADS); patients with cirrhosis and LI-RADS 5 were classified as HCC, while indeterminate lesions underwent biopsy. Of 124 identified cases, 94 met the inclusion criteria after excluding patients with incomplete imaging or insufficient diagnostic confirmation. Sociodemographic, clinical, laboratory, staging, treatment, and survival data were extracted from paper and electronic records, de-identified, and stored in REDCap for analysis. Statistical evaluation was performed using Stata 18, with descriptive statistics applied to continuous and categorical variables. Associations were tested using chi-square tests, t-tests, and ANOVA, while survival outcomes were assessed using Kaplan–Meier curves and log-rank tests. A p-value <0.05 was considered statistically significant.
Results: Most patients were male (67%) and aged 31–59 years (51%). Key risk factors included hepatitis B (44.7%), alcohol use (39.4%), and hepatitis C (6.4%). Advanced disease was common: 63.8% had ECOG performance status 2–3, and 42.5% had no liver cirrhosis. Only 18% received systemic therapy (mostly sorafenib); none underwent curative procedures. Median survival was 4.73 months, with an interquartile range (IQR) of 0.92-12.42 and a 13% one-year survival rate. Poor outcomes were statistically associated with high AFP levels, hepatitis B infection, lack of health insurance, and poor performance status.
Conclusion: Hepatocellular carcinoma is a significant health burden in northern Tanzania, with a high incidence of late-stage presentations, limited treatment options, and poor outcomes. Early detection through routine screening for high-risk populations, improved access to diagnostic and therapeutic services are critical to improving survival and quality of life for HCC patients. Public health interventions focused on reducing hepatitis B and C prevalence as well as alcohol use are essential for reducing the future burden of liver cancer in Tanzania.