Liver Cancer Survival and Prognostic Factors in a High Endemic Area of Hepatitis B

Abstract

Background: Hepatitis B infection is a global public health problem especially in developing countries with high prevalence, and liver cancer is its most feared complication. In these countries the majority of infections occur in early childhood with the corollary of a frequent transition to chronicity and increased risk of liver cancer. For various reasons, these cancers are diagnosed at a late stage, resulting a high mortality rate. The aim of this work was to study survival and prognostic factors in patients with liver cancer in the gastroenterology department at the Yalgado Ouédraogo University Hospital in Burkina Faso. Patients and Methods : it was a cross-sectional, descriptive and analytical study with retrospective collection in the Gastroenterology department at the Yalgado Ouédraogo University Hospital. The collection period was 12 months, from January 1st to December 31st 2023. The study population consisted of all the patients who had been hospitalized in the Gastroenterology department during the period. Any patient in whom the diagnosis of liver cancer was established was included. The diagnosis was established on clinical and paraclinical criteria. Patients hospitalized with another diagnosis were excluded. The data were analyzed by Epi-Info software. Texts, graphs and table have been produced by Word and Excel Software 2016. Quantitative variables were expressed as mean and standard deviation, and qualitative variables as number and percentage. A difference was considered significant when the p-value was less than 5%. Results : During the study period, 339 patients were hospitalized,107 of whom had liver cancer, representing a prevalence of 31.56%. The mean age was 40.56 years. Men were the most affected, with a sex ratio of 4.6. The mean antecedents were alcohol 33.96%, and hepatitis B. The majority (59.43%) of our patients consulted between 1 and 3 months. Seventy percent of patients were under 60 years old. Hepatitis virus B and/or C were found in 89.7% of cases; 60.74% of our patients were in stage D of BCLC classification; 66.33% had died. The median survival was 2 months, with overall survival at 6 months estimated at 30% and zero at 14 months. In the multivariate cox model, after adjusting for the other covariables, Child-Pugh stage C, BCLC stage D and sex male were statistically associated as prognostic factors of death with Hazar ratios of 2.66; 3.75 and 2.21 respectively. Conclusion: Liver cancer is often diagnosed late in our context with a median survival less than 2 months. Viral hepatitis is the main cause so, preventive measures should be taken as well to decrease liver cancer prevalence.