Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa
PURPOSEHepatocellular carcinoma (HCC) is common and deadly in sub-Saharan Africa, where advanced imaging techniques, such as computerized tomography and magnetic resonance imaging, are scarce. The purpose of this study was to develop a pragmatic HCC diagnostic strategy for such settings.METHODSWe ev...
Saved in:
| Main Authors: | , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2025-06-01
|
| Series: | JCO Global Oncology |
| Online Access: | https://ascopubs.org/doi/10.1200/GO-24-00592 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849469674743398400 |
|---|---|
| author | Gregory D. Kirk Sara Nsibirwa Jim K. Aizire Redeat L. Assefa Antonio Bandala-Jacques Jackson Orem Tongai Maponga Moussa Seydi Gilles Wandeler Amir Mohareb David L. Thomas Fred Okuku Emmanuelle Ochola Ponsiano Ocama |
| author_facet | Gregory D. Kirk Sara Nsibirwa Jim K. Aizire Redeat L. Assefa Antonio Bandala-Jacques Jackson Orem Tongai Maponga Moussa Seydi Gilles Wandeler Amir Mohareb David L. Thomas Fred Okuku Emmanuelle Ochola Ponsiano Ocama |
| author_sort | Gregory D. Kirk |
| collection | DOAJ |
| description | PURPOSEHepatocellular carcinoma (HCC) is common and deadly in sub-Saharan Africa, where advanced imaging techniques, such as computerized tomography and magnetic resonance imaging, are scarce. The purpose of this study was to develop a pragmatic HCC diagnostic strategy for such settings.METHODSWe evaluated standardized protocol-collected data on clinical, ultrasonographic, biochemical, and pathological criteria in a multisite study of 649 suspected HCC cases in Uganda. Participants underwent standardized interviews, clinical assessments, and ultrasound examinations by trained staff with alpha-fetoprotein (AFP) testing at a central laboratory, and pathology was obtained for selected participants. Concordance analysis and percentage-confirmed yield using different HCC case definitions were performed, with survival follow-up as a validation measure.RESULTSThe median age was 45 years, 68% were male, and 45% had chronic hepatitis B infection. Ultrasonographic, biochemical (AFP), and pathological definitions confirmed 91%, 57%, and 17% of clinically defined HCC cases, respectively. The median survival after diagnosis was 46 days. An integrated HCC case definition that combined clinical criteria with one confirmatory test increased the percentage-confirmed yield by 3.7% (ultrasonographic), 37.7% (biochemical), and 77.7% (pathologic) over the clinical definition alone. Yield from AFP or pathology beyond ultrasound was minimal. Survival did not differ appreciably by HCC case definition. This integrated HCC case definition maintained diagnostic rigor while maximizing yield.CONCLUSIONWe propose an integrated HCC case definition as a pragmatic, resource-adaptable approach for clinical diagnosis and research in sub-Saharan Africa. This definition can be readily implemented and can support regional collaborative efforts to develop novel diagnostics and improved treatments to ameliorate the heavy HCC burden. |
| format | Article |
| id | doaj-art-0c671f93ff7a4adeb7b49af40e6af3ab |
| institution | Kabale University |
| issn | 2687-8941 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | JCO Global Oncology |
| spelling | doaj-art-0c671f93ff7a4adeb7b49af40e6af3ab2025-08-20T03:25:23ZengAmerican Society of Clinical OncologyJCO Global Oncology2687-89412025-06-011110.1200/GO-24-00592Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in AfricaGregory D. Kirk0Sara Nsibirwa1Jim K. Aizire2Redeat L. Assefa3Antonio Bandala-Jacques4Jackson Orem5Tongai Maponga6Moussa Seydi7Gilles Wandeler8Amir Mohareb9David L. Thomas10Fred Okuku11Emmanuelle Ochola12Ponsiano Ocama13Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDInfectious Disease Institute, Makerere University, Kampala, UgandaDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MDUganda Cancer Institute, Kampala, UgandaDepartment of Pathology, National Health Laboratory Service, Stellenbosch University, Cape Town, South AfricaService de Maladies Infectieuses et Tropicales, Fann University Hospital, Dakar, SenegalDepartment of Infectious Diseases, University of Bern, Bern, SwitzerlandCenter for Global Health, Division of Infectious Diseases, Massachusetts General Hospital, Boston, MADepartment of Medicine, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, MDUganda Cancer Institute, Kampala, UgandaSt Mary's Lacor Hospital, Gulu, UgandaInfectious Disease Institute, Makerere University, Kampala, UgandaPURPOSEHepatocellular carcinoma (HCC) is common and deadly in sub-Saharan Africa, where advanced imaging techniques, such as computerized tomography and magnetic resonance imaging, are scarce. The purpose of this study was to develop a pragmatic HCC diagnostic strategy for such settings.METHODSWe evaluated standardized protocol-collected data on clinical, ultrasonographic, biochemical, and pathological criteria in a multisite study of 649 suspected HCC cases in Uganda. Participants underwent standardized interviews, clinical assessments, and ultrasound examinations by trained staff with alpha-fetoprotein (AFP) testing at a central laboratory, and pathology was obtained for selected participants. Concordance analysis and percentage-confirmed yield using different HCC case definitions were performed, with survival follow-up as a validation measure.RESULTSThe median age was 45 years, 68% were male, and 45% had chronic hepatitis B infection. Ultrasonographic, biochemical (AFP), and pathological definitions confirmed 91%, 57%, and 17% of clinically defined HCC cases, respectively. The median survival after diagnosis was 46 days. An integrated HCC case definition that combined clinical criteria with one confirmatory test increased the percentage-confirmed yield by 3.7% (ultrasonographic), 37.7% (biochemical), and 77.7% (pathologic) over the clinical definition alone. Yield from AFP or pathology beyond ultrasound was minimal. Survival did not differ appreciably by HCC case definition. This integrated HCC case definition maintained diagnostic rigor while maximizing yield.CONCLUSIONWe propose an integrated HCC case definition as a pragmatic, resource-adaptable approach for clinical diagnosis and research in sub-Saharan Africa. This definition can be readily implemented and can support regional collaborative efforts to develop novel diagnostics and improved treatments to ameliorate the heavy HCC burden.https://ascopubs.org/doi/10.1200/GO-24-00592 |
| spellingShingle | Gregory D. Kirk Sara Nsibirwa Jim K. Aizire Redeat L. Assefa Antonio Bandala-Jacques Jackson Orem Tongai Maponga Moussa Seydi Gilles Wandeler Amir Mohareb David L. Thomas Fred Okuku Emmanuelle Ochola Ponsiano Ocama Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa JCO Global Oncology |
| title | Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa |
| title_full | Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa |
| title_fullStr | Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa |
| title_full_unstemmed | Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa |
| title_short | Pragmatic Approach to Hepatocellular Carcinoma Diagnosis in High-Incidence, Resource-Limited Settings in Africa |
| title_sort | pragmatic approach to hepatocellular carcinoma diagnosis in high incidence resource limited settings in africa |
| url | https://ascopubs.org/doi/10.1200/GO-24-00592 |
| work_keys_str_mv | AT gregorydkirk pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT saransibirwa pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT jimkaizire pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT redeatlassefa pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT antoniobandalajacques pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT jacksonorem pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT tongaimaponga pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT moussaseydi pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT gilleswandeler pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT amirmohareb pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT davidlthomas pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT fredokuku pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT emmanuelleochola pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica AT ponsianoocama pragmaticapproachtohepatocellularcarcinomadiagnosisinhighincidenceresourcelimitedsettingsinafrica |