The spectrum and outcome of metastatic hepatocellular carcinoma in a South African patient cohort

Abstract

Background

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally, particularly in developing countries in Southeast Asia and sub-Saharan Africa (SSA), where chronic hepatitis B virus (HBV) dominates as a major aetiological factor.

Methods

We conducted a retrospective cohort study to quantify the metastatic profile of HCC in a South African patient population managed at a tertiary centre. Demographic, clinical and treatment data were extracted from an institutional registry. Patients with and without metastases were compared to identify factors associated with an increased risk of developing metastases.

Results

Of 676 patients, 194 (28.7 %) had metastases. Patients with metastases were younger (46.37 vs. 52.23 years; p < 0.00001) and more frequently had chronic HBV, HIV co-infection and schistosomiasis compared to non-metastatic patients. The most common metastatic sites were lungs, skeletal, and peritoneum. For non-treated patients, skeletal metastases had the poorest survival.

Conclusion

This study confirms a typical SSA disease profile of aggressive HCC in a young population. We reported on the metastatic profile of HCC and the impact of different metastases on survival. Future research should focus on defining the concept of oligometastatic disease in HCC to identify patients where intervention targeting metastatic disease may be of benefit.