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Updated: Jun 24, 2026
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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: 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.
The British Journal of Surgery
|June 22, 2026
Summary
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.
