PDF(Pubmed)
Abstract：
OBJECTIVE: Hepatocellular carcinoma (HCC), the fourth most common cancer in Africa, has a dismal overall survival of only 3 months like in sub-Saharan Africa. This is affected by the low gross domestic product and human development index, absence of coherent guidelines, and other factors.
METHODS: An open forum for HCC-experienced health care workers from Africa and the rest of the world was held in October 2021. Participants completed a survey to help assess the real-life access to screening, diagnoses, and treatment in the North and Southern Africa (NS), East and West Africa (EW), Central Africa (C), and the rest of the world.
RESULTS: Of 461 participants from all relevant subspecialties, 372 were from Africa. Most African participants provided hepatitis B vaccination and treatment for hepatitis B and C. More than half of the participants use serum alpha-fetoprotein and ultrasound for surveillance. Only 20% reported using image-guided diagnostic liver biopsy. The Barcelona Clinic Liver Cancer is the most used staging system (52%). Liver transplant is available for only 28% of NS and 3% EW. C reported a significantly lower availability of resection. Availability of local therapy ranged from 94% in NS to 62% in C. Sorafenib is the most commonly used systemic therapy (66%). Only 12.9% reported access to other medications including immune checkpoint inhibitors. Besides 42% access to regorafenib in NS, second-line treatments were not provided.
CONCLUSIONS: Similarities and differences in the care for patients with HCC in Africa are reported. This reconfirms the major gaps in access and availability especially in C and marginally less so in EW. This is a call for concerted multidisciplinary efforts to achieve and sustain a reduction in incidence and mortality from HCC in Africa.
METHODS: An open forum for HCC-experienced health care workers from Africa and the rest of the world was held in October 2021. Participants completed a survey to help assess the real-life access to screening, diagnoses, and treatment in the North and Southern Africa (NS), East and West Africa (EW), Central Africa (C), and the rest of the world.
RESULTS: Of 461 participants from all relevant subspecialties, 372 were from Africa. Most African participants provided hepatitis B vaccination and treatment for hepatitis B and C. More than half of the participants use serum alpha-fetoprotein and ultrasound for surveillance. Only 20% reported using image-guided diagnostic liver biopsy. The Barcelona Clinic Liver Cancer is the most used staging system (52%). Liver transplant is available for only 28% of NS and 3% EW. C reported a significantly lower availability of resection. Availability of local therapy ranged from 94% in NS to 62% in C. Sorafenib is the most commonly used systemic therapy (66%). Only 12.9% reported access to other medications including immune checkpoint inhibitors. Besides 42% access to regorafenib in NS, second-line treatments were not provided.
CONCLUSIONS: Similarities and differences in the care for patients with HCC in Africa are reported. This reconfirms the major gaps in access and availability especially in C and marginally less so in EW. This is a call for concerted multidisciplinary efforts to achieve and sustain a reduction in incidence and mortality from HCC in Africa.
摘要：
目标：肝细胞癌（HCC），非洲第四大最常见的癌症，像撒哈拉以南非洲一样，整体生存期仅为3个月。这受到国内生产总值和人类发展指数较低的影响,缺乏连贯的指导方针，和其他因素。
方法：2021年10月为来自非洲和世界其他地区的HCC经验丰富的卫生保健工作者举行了公开论坛。参与者完成了一项调查，以帮助评估现实生活中的筛查，诊断,以及北非和南部非洲（NS）的治疗，东非和西非（EW）中部非洲(C),和世界其他地方。
结果：来自所有相关亚专业的461名参与者，372来自非洲。大多数非洲参与者提供乙肝疫苗接种和治疗乙肝和丙肝超过一半的参与者使用血清甲胎蛋白和超声监测。只有20％的报告使用图像引导诊断肝活检。巴塞罗那诊所肝癌是最常用的分期系统（52％）。肝移植仅适用于28％的NS和3％的EW。C报告切除的可用性明显较低。局部治疗的可用性范围从NS的94%到C的62%。索拉非尼是最常用的全身治疗(66%)。只有12.9%的人报告使用其他药物，包括免疫检查点抑制剂。除了42%的人在NS中使用regorafenib，未提供二线治疗.
结论：报告了非洲HCC患者护理的异同。这再次证实了在访问和可用性方面的主要差距，尤其是在C中，而在EW中的差距则较小。这呼吁采取协调一致的多学科努力，以实现并维持减少非洲HCC的发病率和死亡率。
方法：2021年10月为来自非洲和世界其他地区的HCC经验丰富的卫生保健工作者举行了公开论坛。参与者完成了一项调查，以帮助评估现实生活中的筛查，诊断,以及北非和南部非洲（NS）的治疗，东非和西非（EW）中部非洲(C),和世界其他地方。
结果：来自所有相关亚专业的461名参与者，372来自非洲。大多数非洲参与者提供乙肝疫苗接种和治疗乙肝和丙肝超过一半的参与者使用血清甲胎蛋白和超声监测。只有20％的报告使用图像引导诊断肝活检。巴塞罗那诊所肝癌是最常用的分期系统（52％）。肝移植仅适用于28％的NS和3％的EW。C报告切除的可用性明显较低。局部治疗的可用性范围从NS的94%到C的62%。索拉非尼是最常用的全身治疗(66%)。只有12.9%的人报告使用其他药物，包括免疫检查点抑制剂。除了42%的人在NS中使用regorafenib，未提供二线治疗.
结论：报告了非洲HCC患者护理的异同。这再次证实了在访问和可用性方面的主要差距，尤其是在C中，而在EW中的差距则较小。这呼吁采取协调一致的多学科努力，以实现并维持减少非洲HCC的发病率和死亡率。
