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Updated: Jun 24, 2026
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Global disparities in hepatocellular carcinoma outcomes: a multicentre study
Sanju Sobnach1, Haytham Bayadsi2, Urda Kotze1
1Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Insights
Hepatocellular carcinoma patients in South Africa present with more advanced disease and receive less curative treatment than in Sweden. This leads to significantly lower survival rates, highlighting the need for region-specific guidelines.
Area of Science:
- Hepatobiliary Medicine
- Oncology
- Global Health Equity
Background:
- Sub-Saharan Africa faces a high burden of hepatocellular carcinoma (HCC).
- Current HCC clinical guidelines are often based on data from high-income countries, potentially limiting their applicability in Africa.
- Significant disparities exist in HCC presentation, treatment, and outcomes between South Africa and Sweden.
Purpose of the Study:
- To compare the presentation, treatment, and outcomes of hepatocellular carcinoma (HCC) between South Africa and Sweden.
- To evaluate the limitations of applying high-income country-derived HCC guidelines in sub-Saharan Africa.
Main Methods:
- A comparative cohort study of 959 adult HCC patients treated between 2012 and 2023.
- Patients were treated at referral centers in South Africa (n=455) and Sweden (n=504).
- Primary outcome was overall survival; secondary outcome was treatment-specific survival.
Main Results:
- South African patients were younger (median 50 vs. 71 years) and predominantly had Hepatitis B virus-related HCC (60% vs. 3.6%).
- Patients in South Africa presented with more advanced liver dysfunction, higher rates of metastasis, and more advanced BCLC stages.
- Curative-intent therapies were offered to 9.2% in South Africa versus 42.5% in Sweden (P<0.001), resulting in significantly lower 1, 3, and 5-year survival rates (17.8%, 7.7%, 5.3% vs. 58.9%, 35.3%, 26.2%).
Conclusions:
- Marked disparities in HCC disease presentation, treatment access, and survival exist between South Africa and Sweden.
- Current treatment paradigms and guidelines derived from high-income countries are inadequate for sub-Saharan Africa.
- Tailored, region-specific guidelines are urgently needed to address HCC inequities and improve patient outcomes in sub-Saharan Africa.
Background:
Sub-Saharan Africa carries a disproportionate burden of hepatocellular carcinoma (HCC), yet clinical guidelines used on the African subcontinent are extrapolated from high-income countries (HICs). The presentation, treatment, and outcomes of HCC were compared between liver referral centres in South Africa and Sweden to examine the limitations of applying HIC-derived guidelines to sub-Saharan Africa.
Methods:
This was a comparative cohort study of adult patients with HCC treated from 2012 to 2023 in a referral centre in South Africa and in a referral centre in Sweden. The main and secondary outcomes were overall survival (OS) and treatment-specific survival respectively.
Results:
Of 959 patients included, 455 and 504 were treated in South Africa and Sweden respectively. Patients in South Africa were younger (median 50 versus 71 years, P < 0.001) and predominantly had hepatitis B virus (HBV)-related HCC (60% versus 3.6%, P < 0.001). They presented with more advanced liver dysfunction, more frequent metastases, and more advanced Barcelona Clinic Liver Cancer (BCLC) stage. Curative-intent therapies (ablation, liver resection, or liver transplantation) were offered to 9.2% and 42.5% of patients respectively (P < 0.001). OS rates at 1 year, 3 years, and 5 years were 17.8%, 7.7%, and 5.3% versus 59.3%, 35.3%, and 27.0% respectively (P < 0.001). Survival was consistently lower for the patients in South Africa when comparing treatment-specific cohorts.
Conclusion:
Marked disparities in disease presentation, access to treatment, and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes.
