Histopathological subtypes and topographical subsites of gastric cancer in Sub-Saharan Africa: a scoping review.

backgroundPrecision medicine in gastric cancer management involves accurate diagnosis, accurate staging, minimally invasive surgery for early disease, and targeted therapies or immunomodulation for advanced disease. The current approach to the management of gastric cancer relies on the tumor-node and metastasis (TNM) classification, which has been shown to have limitations. Molecular and genetic diagnoses are accurate and available, but expensive. The modified Laurén classification has been proposed and is based on the tumor location, tumor histology, and clinical course. This classification relates well to patient prognosis and could offer an accessible option for achieving individualised care in gastric cancer management.

aimTo map the evidence on the patterns of gastric cancer by histopathological subtype and topographical subsite in Sub-Saharan Africa (SSA).

methodsPrimary studies on gastric cancer, particularly adenocarcinoma, published between 2003 and 2024 in Sub-Saharan Africa were eligible. PubMed, Web of Science, and Google Scholar were searched using a predetermined strategy. Reports not in English, inaccessible abstracts/full texts, and those outside Sub-Saharan Africa were excluded. Data were charted using a pretested Google Form to capture publication year, author, country, study design, population size, sex, age, histological subtype, and topographical subsite. Descriptive analysis was employed for synthesis.

resultsAfter screening 214 studies, the databases yielded 20 studies that were included in the analysis from nine SSA countries. Most of the studies were retrospective in nature. The intestinal histopathological subtype and the non-cardia topographical subsite were the most predominant. Two studies evaluated the association of Helicobacter pylori with the histopathological subtypes. Three studies evaluated early-onset gastric cancer with a predominance of the intestinal histopathological subtype.

conclusionAlthough the reviewed studies encompassed diverse regions within SSA, the lack of prospective designs and the concentration of data from only a few countries limit broader applicability. Interestingly, early-onset gastric cancer in these studies predominantly exhibited the intestinal subtype-contrasting with the diffuse subtype commonly reported in Asian and Western studies. These findings highlight the need for regionally representative, prospective research to better scrutinize gastric cancer subtypes, subsites, and epidemiological patterns across the continent.