Primary liver cancer at tertiary healthcare facility in Guinea: a cross-sectional study

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Abstract
Guinea has the highest incidence of hepatocellular carcinoma (HCC) in Sub-Saharan Africa (> 21 cases/100,000 habitants/year). This high incidence is largely attributed to the combination of a high prevalence of chronic hepatitis B virus (HBV) infection and significant exposure to aflatoxin B1 (AFB1), a known carcinogen. However, the clinical presentation of HCC in Guinea has not been well-documented to date. We conducted a retrospective analysis of 216 HCC cases from patients who received care between 2015 and 2023 at the Donka University Hospital in Conakry, the main tertiary care institution of the country. Demographical, clinical, and biological data were extracted from medical records and analyzed using both descriptive and inferential statistics. The median age of patients was relatively young, at 43.0 years (IQR = 34.5-55.0) with a male-to-female ratio of 3.1 (162/54). Half of the male patients were younger than 41 years. Chronic HBV infection was the predominant risk factor accounting for 75.0% of cases. Almost all patients have been exposed to HBV at some moment of their lives (total anti-HBc seropositivity: 92.2%). Chronic HBV infection was rarely replicative with only 7.8% of patients tested positive for HBeAg. Hepatitis C virus Infection was observed in a small subset of cases (7.9%). Toxic risk factors such as alcohol (12.5%) or tobacco (19.4%) were also rather infrequent. HBV-infected patients were significantly younger than non-HBV patients (median age: 40.0 vs. 50.5 years, p = 0.0109). Susu ethnicity, a Mande-speaking group primarily residing in Guinea's coastal plain was associated with an earlier onset of HCC than other ethnic groups (median age: 37.0 vs. 46.0 years, p = 0.0007). HBV infection is the major risk factor of HCC in Guinea with an earlier onset of the disease by nearly a decade compared to other risk factors. A notable ethnic variation was observed with Susu patients displaying a predisposition to early HCC. Further molecular research is needed to precisely assess the potential role of AFB1 in liver carcinogenesis of Guinean populations.

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