Assessing hepatocellular carcinoma in Nigeria: A multicenter retrospective cohort review of prevalence, risk factors, and treatment outcomes

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is a major cause of cancer deaths globally, with Nigeria’s rising burden fueled by viral hepatitis, environmental toxins, and lifestyle factors. Limited national data on HCC prevalence, risk factors, and treatment outcomes, due to diagnostic and healthcare challenges, hinder effective response. This multicenter study aims to determine the prevalence, identify key risk factors, and assess treatment patterns across Nigerian healthcare facilities, providing insights to improve early detection, guide public health strategies, and develop tailored management guidelines to enhance patient survival.

AIM

To determine the prevalence, identify key risk factors, and assess treatment patterns across Nigerian healthcare facilities, providing insights to improve early detection, guide public health strategies, and develop tailored management guidelines to enhance patient survival.

METHODS

This retrospective cohort review was conducted across gastroenterology units in 16 Nigerian healthcare facilities, representing both urban and rural settings, from January 2024 to December 2024. Adults aged 18 years and older diagnosed with HCC based on clinical, biochemical, imaging, and/or histopathological criteria were eligible; those with a prior history of malignancies or with incomplete records precluding data extraction were excluded. The study employed two-staged data-entry forms to capture distinct layers of information. Form A was designed to collect data on the entire gastroenterology patient population seen within 2024, including both patients with and without HCC, to allow estimation of HCC prevalence within the gastroenterology cohort and to summarize aggregate demographic and clinical features. Form B was dedicated to detailed abstraction of HCC-specific cases with identifiable records, drawing on complete, provenance-traceable data to characterize individual cases comprehensively (e.g., diagnostics, staging, treatment, and outcomes). Data collection utilized standardized tools to capture demographics, clinical features, diagnostics, staging, treatment modalities, and outcomes. Descriptive statistics summarized overall and HCC-specific cohorts, while logistic regression explored associations between risk factors and HCC-related outcomes. Ethical approval was obtained from the relevant institutional review boards, and confidentiality was maintained in accordance with applicable guidelines.

RESULTS

A total of 5760 gastroenterology cases were recruited, among which 412 were confirmed HCC, yielding a prevalence of 7.2% for HCC within the gastroenterology cohort. This study employed a two-form data entry: Form A was applied to the total gastroenterology cohort to estimate prevalence and characterize aggregate features, identifying 5760 cases with 412 confirmed HCC diagnoses. Form B was applied to individual HCC cases with available records for detailed case-level analysis. It recorded 319 cases for in-depth characterization. Regional prevalence varied from 3.4% in the South-East to 17.5% in the North-East. The cohort was predominantly male (77.6%) with a mean age of 49.4 years. Chronic hepatitis B virus infection accounted for 55.2% of cases; alcohol-related liver disease was present in 18.2% (noting that among those with alcoholic liver disease, more than half consumed ≥ 40 units of alcohol per week); hepatitis C virus (HCV) infection accounted for 5.6%; smoking was present in 3.8%; and metabolic-associated steatotic liver disease accounted for 3.5%. Common presenting symptoms included right upper abdominal pain (85.2%), abdominal swelling (84.9%), and a palpable right upper abdominal mass (78.2%), with a median diagnostic interval of approximately 3 months. Liver function was often compromised, with a substantial proportion presenting Child-Pugh B or C. Diagnostic imaging primarily involved abdominal ultrasound (85.2%) and contrast-enhanced computed tomography (41.6%). About half of the patients were diagnosed at advanced Barcelona Clinic Liver Cancer stages (C or D). Laboratory data showed elevated alpha fetoprotein in more than half of patients, with notable abnormalities in urea and international normalized ratio. Treatments included systemic therapy (predominantly sorafenib), surgical interventions, locoregional therapies, and palliative care, with regional variation in treatment choices influenced by local resources and access. At follow-up, nearly half of the patients experienced worsening symptoms, a minority showed improvement (10.1%), and 12.3% were alive at the end of the follow-up period. Prognostic factors significantly associated with outcomes included ascites, encephalopathy, performance status, and tumor stage, with ongoing alcohol use linked to increased progression.

CONCLUSION

Nigeria’s HCC prevalence was 7.2%, with regional differences, and most cases presented at advanced stages. Hepatitis B was the primary risk factor, alongside alcohol and HCV. Treatment approaches varied regionally, but overall survival remained poor, underscoring the urgent need for improved early detection, screening, and healthcare infrastructure. These findings inform public health policies and strategies for HCC management in Nigeria.

Keywords: Hepatocellular carcinoma; Chronic hepatitis B virus; Chronic hepatitis C virus; Aflatoxin; Late presentation; Surgical resection; Locoregional therapy; Systemic therapy

Core Tip: This multicenter study reveals a 7.2% prevalence of hepatocellular carcinoma (HCC) across Nigeria, with most cases diagnosed at advanced stages. Hepatitis B remains the leading risk factor, compounded by lifestyle and environmental factors. Regional variations in prevalence and treatment patterns highlight disparities in healthcare access and infrastructure. Despite the availability of diverse treatment options, survival rates remain low, underscoring the urgent need for improved early detection, screening, and targeted public health strategies. These findings provide critical insights to guide policy development, enhance management protocols, and ultimately improve outcomes for patients with HCC in Nigeria.