Sobnach Sanju, Emmamally Muhammad, Venter Keith, Krige Jake, Bernon Marc, Kloppers Christo, Sonderup Mark W, Spearman C Wendy, Khan Rufaida, Kotze Urda, Jonas Eduard
Surgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
World J Surg. 2025 May;49(5):1290-1297. doi: 10.1002/wjs.12559. Epub 2025 Mar 18.
The impact of healthcare disparities on the outcomes for hepatocellular carcinoma (HCC) has not been explored in South Africa. This study aims to evaluate and compare the presentation, treatment, and outcomes of HCC in a cohort of patients treated in the public and private sectors.
The records of 551 consecutive patients treated at a public hospital compared to those of 51 treated in the private sector from 1 December 2001 to 29 February 2024 were retrospectively reviewed.
Patients managed in the public sector were significantly younger (mean age: 49.6 ± 14.8 vs. 59.6 ± 14.3 years, p < 0.00001) and more likely to have hepatitis B virus (HBV)-related HCC (62.1% vs. 17.6%, p < 0.00001). The prevalence of multifocal disease (59.2% vs. 15.7%, p < 0.00001), portal vein tumor thrombosis (44.6% vs. 5.9%, p < 0.00001), and pulmonary metastases (16.2% vs. 3.9%, p = 0.0143) was significantly higher in public sector patients. A significantly higher number of public sector patients received best supportive care as their only treatment (69.7% vs. 15.7%, p < 0.00001). A higher proportion of private sector patients were treated with curative-intended therapies (ablation, liver resection, and liver transplantation) and transarterial modalities. Median survival was lower in public sector patients (68 [IQR: 25-232] vs. 703 [IQR: 388-1327] days, p < 0.001). There was no difference in survival between public and private sector patients treated with curative-intended therapies.
In the public sector, patients present with more advanced HCC, which limits their access to curative-intended therapies, resulting in lower survival. Patients treated with curative-intended therapies have similar survival rates in the public and private sectors. With the introduction of universal health coverage through the National Health Insurance program in South Africa, these data highlight the gaps in HCC care in the public sector, where health initiatives such as HBV vaccination, early treatment of HBV, patient education, and screening of at-risk patients should be prioritized.
在南非，医疗保健差异对肝细胞癌（HCC）治疗结果的影响尚未得到研究。本研究旨在评估和比较在公共部门和私营部门接受治疗的一组HCC患者的临床表现、治疗方法及治疗结果。
回顾性分析了2001年12月1日至2024年2月29日期间在一家公立医院接受治疗的551例连续患者的记录，并与在私营部门接受治疗的51例患者的记录进行比较。
在公共部门接受治疗的患者明显更年轻（平均年龄：49.6±14.8岁 vs. 59.6±14.3岁，p<0.00001），且更有可能患有乙型肝炎病毒（HBV）相关的HCC（62.1% vs. 17.6%，p<0.00001）。公共部门患者多灶性疾病（59.2% vs. 15.7%，p<0.00001）、门静脉肿瘤血栓形成（44.6% vs. 5.9%，p<0.00001）和肺转移（16.2% vs. 3.9%，p=0.0143）的患病率显著更高。公共部门患者中接受最佳支持治疗作为唯一治疗方法的人数明显更多（69.7% vs. 15.7%，p<0.00001）。私营部门患者中接受根治性治疗（消融、肝切除和肝移植）和经动脉治疗的比例更高。公共部门患者的中位生存期较低（68[四分位间距：25 - 232]天 vs. 703[四分位间距：388 - 1327]天，p<0.001）。接受根治性治疗的公共部门和私营部门患者之间的生存期没有差异。
在公共部门，患者的HCC病情更严重，这限制了他们获得根治性治疗的机会，导致生存期较短。接受根治性治疗的患者在公共部门和私营部门的生存率相似。随着南非通过国家健康保险计划引入全民健康覆盖，这些数据凸显了公共部门在HCC护理方面的差距，在公共部门应优先开展诸如HBV疫苗接种、HBV早期治疗、患者教育以及对高危患者进行筛查等健康举措。
