Evidence map›Paper›PMID 40101972›Full record

ArticleWorld journal of surgery2025

Healthcare Disparities in the Treatment and Outcomes of Hepatocellular Carcinoma in South Africa.

Sanju Sobnach, Muhammad Emmamally, Keith Venter, Jake Krige, Marc Bernon, Christo Kloppers, Mark W Sonderup, C Wendy Spearman, Rufaida Khan, Urda Kotze and 1 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in World journal of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Review
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Sanju SobnachSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-4456-2115
Muhammad EmmamallySurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0009-0005-2148-685X
Keith VenterSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0001-6910-1756
Jake KrigeSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-7057-9156
Marc BernonSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0002-7967-8548
Christo KloppersSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0003-2438-6879
Mark W SonderupDivision of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0001-7128-8329
C Wendy SpearmanDivision of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0003-3199-301X
Rufaida KhanSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0009-0002-9638-5314
Urda KotzeSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0003-1405-474X
Eduard JonasSurgical Gastroenterology Unit, Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.ORCID 0000-0003-0123-256X

Funding

Harry Crossley Foundation
6 · The paper itself

Abstract

backgroundThe 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.

methodsThe 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.

resultsPatients 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.

conclusionsIn 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.

Indexed as

Carcinoma, HepatocellularHealthcare DisparitiesLiver NeoplasmsAdultAgedFemaleHospitals, PublicHumansMaleMiddle AgedPrivate SectorPublic SectorRetrospective StudiesSouth AfricaTreatment Outcomedisparitieshepatocellular carcinomaoutcomesprivate healthcareSouth Africa

Identifiers

PMID40101972
PMCPMC12058446

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.