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Outcomes of jaundice in advanced hepatocellular carcinoma - a sub-Saharan perspective
P B Keshaw1, M Bernon1, M Emmamally1
1Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, Groote Schuur Hospital University of Cape Town, South Africa.
Insights
Jaundice in hepatocellular carcinoma (HCC) patients indicates advanced disease. Biliary drainage improved survival for obstructive jaundice cases, but overall survival remained poor for jaundiced HCC patients in sub-Saharan Africa.
Area of Science:
- Hepatobiliary Medicine
- Oncology
- Gastroenterology
Background:
- Jaundice signifies advanced hepatocellular carcinoma (HCC) with poor prognosis.
- Sub-Saharan Africa (SSA) faces unique challenges in managing HCC.
- Understanding outcomes for jaundiced HCC patients in SSA is crucial.
Purpose of the Study:
- To analyze the management and outcomes of jaundiced HCC patients.
- To describe treatment strategies at a major academic referral center in SSA.
- To evaluate survival differences based on jaundice etiology and treatment.
Main Methods:
- Retrospective analysis of treatment-naïve adult HCC patients with jaundice (1990-2023).
- Categorization into diffuse tumor infiltration and obstructive jaundice (OJ).
- Comparison of outcomes between best supportive care (BSC) and biliary drainage (BD) for OJ.
Main Results:
- 126 jaundiced HCC patients identified; 70.6% male, mean age 48.8 years.
- 94% with diffuse infiltration received BSC; 28 with OJ received BD (16) or BSC (12).
- Biliary drainage in OJ patients significantly improved survival (117.9 days) compared to BSC (29.2 days).
Conclusions:
- Jaundiced HCC patients in SSA have a poor overall survival.
- Biliary drainage offers a survival benefit for obstructive jaundice in HCC.
- Further research is needed to improve outcomes for this patient group.
Background:
Jaundice is a marker of advanced disease and poor outcomes in hepatocellular carcinoma (HCC). The aim of this study was to describe and analyse the management and outcomes of jaundiced HCC patients at a large academic referral centre in sub-Saharan Africa (SSA).
Methods:
Treatment-naïve adult HCC patients who presented with jaundice between 1990 and 2023 were analysed.
Results:
During the inclusion period, 676 HCC patients were treated at Groote Schuur Hospital. The mean age of the 126 (18.6%) who were jaundiced was 48.8 (± 13.2) years. Eighty-nine (70.6%) were male. Ninety-four (74.6%) patients with jaundice secondary to diffuse tumour infiltration had best supportive care (BSC) only. Thirty-two had obstructive jaundice (OJ); four were excluded because of missing hospital records. In 28 of these patients, 16 underwent biliary drainage (BD) and 12 received BSC only. The mean overall survival (OS) of the 126 patients was 100.5 (± 242.3) days. The patients with diffuse tumour infiltration had an OS of 105.9 (± 273.3) days. The patients with OJ survived 86.5 (± 135.0) days. There was no significant difference in OS between the three patient groups (p = 0.941). In the OJ group, patients who underwent BD survived longer than the BSC group (117.9 ± 166.4 vs. 29.2 ± 34.7 days, p = 0.015).
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