{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:24:41Z","timestamp":1787063081055,"version":"build-2736575974"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T00:00:00Z","timestamp":1782086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Harry Crossley Clinical Fellowship"},{"name":"Harry Crossley Foundation at the University of Cape Town"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,8,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sub-Saharan Africa carries a disproportionate burden of hepatocellular carcinoma (HCC), yet clinical guidelines used on the African subcontinent are extrapolated from high-income countries (HICs). The presentation, treatment, and outcomes of HCC were compared between liver referral centres in South Africa and Sweden to examine the limitations of applying HIC-derived guidelines to sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a comparative cohort study of adult patients with HCC treated from 2012 to 2023 in a referral centre in South Africa and in a referral centre in Sweden. The main and secondary outcomes were overall survival (OS) and treatment-specific survival respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 959 patients included, 455 and 504 were treated in South Africa and Sweden respectively. Patients in South Africa were younger (median 50 versus 71\u2005years, P &amp;lt; 0.001) and predominantly had hepatitis B virus (HBV)-related HCC (60% versus 3.6%, P &amp;lt; 0.001). They presented with more advanced liver dysfunction, more frequent metastases, and more advanced Barcelona Clinic Liver Cancer (BCLC) stage. Curative-intent therapies (ablation, liver resection, or liver transplantation) were offered to 9.2% and 42.5% of patients respectively (P &amp;lt; 0.001). OS rates at 1\u2005year, 3\u2005years, and 5\u2005years were 17.8%, 7.7%, and 5.3% versus 59.3%, 35.3%, and 27.0% respectively (P &amp;lt; 0.001). Survival was consistently lower for the patients in South Africa when comparing treatment-specific cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Marked disparities in disease presentation, access to treatment, and survival were observed between regions. Tailored regional guidelines are urgently needed to address these inequities and improve outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjs\/znag079","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T11:17:50Z","timestamp":1781695070000},"source":"Crossref","is-referenced-by-count":0,"title":["Global disparities in hepatocellular carcinoma outcomes: a multicentre study"],"prefix":"10.1093","volume":"113","author":[{"given":"Sanju","family":"Sobnach","sequence":"first","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haytham","family":"Bayadsi","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention\/Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Urda","family":"Kotze","sequence":"additional","affiliation":[{"name":"Division of General Surgery, Department of Surgery, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4595-5399","authenticated-orcid":false,"given":"Hanna","family":"Nystr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Intervention\/Surgery, Ume\u00e5 University , Ume\u00e5 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C Wendy","family":"Spearman","sequence":"additional","affiliation":[{"name":"Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town , Cape Town ,","place":["South 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