HCC is the most common form of primary liver cancer and a major public health problem [1] . It is the sixth most common cancer in the world, responsible for more than 700,000 deaths per year [2] , and generally occurs in the most active age group of the population between 30 and 60 years of age, particularly in sub-Saharan Africa with high mortality [3] [4] .

The geographic distribution of the incidence of HCC tends to mirror that of its major risk factors, chronic hepatitis B and hepatitis C virus infection, which account for approximately 56% and 20% of all HCC cases, respectively [5] - [7] . Historically, sub-Saharan Africa has been classified as hyper-endemic for chronic hepatitis B based on the detection of HBsAg among ≥ 8% of the general population [8] . A general population survey led by Boa in Côte d’Ivoire, found that prevalence of chronic hepatitis B was 13 [9] . Diagnostic methods of HCC have evolved considerably over time, allowing easy diagnosis using minimally invasive methods and early detection using increasingly specific biomarkers, particularly in medically advanced countries [10] . Treatment of HCC is well codified and depends upon the stage of the disease, defined by classifications. The Barcelona clinic liver cancer (BCLC) classification is one of the most widely used [11] [12] . When HCC is discovered at an early stage, curative treatment such as transplantation, liver resection or radiofrequency may be proposed. Unfortunately, in countries with limited resources, HCC mortality remains very high due to late diagnosis and absence of any real program to raise awareness and screen for the main HCC risk factors [8] . Several west African studies have already focused on HCC, but few of them have clearly identified the predictors of poor prognosis of this disease [13] - [16] . A recent study carried out at University Hospital of Bouake, in the Internal Medicine Department showed that HCC accounts for 58.8% of all cancers, but did not deal specifically with epidemiology and prognosis of HCC [17] . The aim of the study was firstly to describe epidemiological aspects and then identify the predictors of mortality to improve management of patients.

We conducted a cross-sectional study using the medical records of patients hospitalized for HCC on a healthy liver or on a cirrhosis liver from 01 January 2020 to 31 December 2022. This was an exhaustive sample of 160 patients with HCC who met the following inclusion criteria:

- All patients with a hepatic nodule on a cirrhotic liver with wash-in wash-out vascular kinetics on abdominal CT;

- All patients with a hepatic nodule or mass on a cirrhotic liver with evidence of portal thrombosis on ultrasound or abdominal CT;

- All patients with histologically confirmed HCC in non-cirrhotic liver with or without significant elevation of AFP. The normal adult value was less than 20 ng/ml. An AFP level ≥ 400 ng/ml was considered significant but a level < 400 ng/ml did not rule out the diagnosis.

Non-inclusion criteria:

- Inpatients without abdominal ultrasound or CT scan;

- Patients with another form of primitive liver cancer;

- Patient with secondary liver cancer;

- Insufficient information in the medical record for the studied parameters.

Data were collected on an anonymous, standardized survey form designed for this purpose. The parameters studied were:

- Socio-demographic (age, sex, level of education, profession, marital status);

- Clinical (performance status (WHO), signs of hepatocellular insufficiency, signs of portal hypertension, Glasgow score, oedema-ascitic decompensation).

- Prognosis: Child’s score, BCLC score, patient outcome;

- Complications of cirrhosis: infection of ascites fluid, digestive hemorrhage, etc.

- Ultrasound parameters (size of liver, number of nodules, presence of portal thrombosis, liver metastases).

Data were processed and analyzed using epi info7 software. Word and Excel were used for graphical representations. Quantitative variables were expressed as median or mean with extremes, and qualitative variables were expressed as proportion. The Chi-square test was applied to find a relationship between qualitative variables. When the expected number of participants was less than 5, the Fisher test was applied. The significance level was less than 5% for univariate analyses. Then we performed multivariate analysis when a link was found.

The study respected the principles of the Declaration of Helsinki.

During the study period, 4341 patients were hospitalized in the Internal Medicine Department, including 160 for HCC, representing a prevalence of 3.6%. The mean age was 48.86 ± 14.5 years, with extremes of 14 and 90 years, and the sex ratio was 2.90. Patients were mainly farmers (41%) and housewife (21%). The sociodemographic characteristics of patients are presented in Table 1 . The performance status was ≥ 2 in 93.2%. Hepatic encephalopathy was found in 28.1% and HCC was discovered at an advanced stage in 98.8%. The nodules size was > 3 cm (89.3%), multiple (72.1%) with vascular invasion (34.4%) and extra-hepatic metastasis (43.4%) as detailed in Table 2 , showing clinical and radiological characteristics of patients with HCC. In-hospital mortality was 20% and BCLC D score was significantly associated with death in univariate analysis. Length of stay <5 days, RR = 0.77 (0.61; 0.96) and hepatic encephalopathy, RR = 1.39 (1.10; 1.77), were the two independent predictors of mortality ( Table 3 ).

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The aim of the study was to describe the epidemiology and determine prognostic factors of HCC in the Internal Medicine Department of Bouake University Hospital in order to improve patients management.

The comparison of our prognostic results with those of other authors Africa (Côte d’Ivoire, Benin, Gambia) and Europe (France) consistently showed that patients presented late with advanced HCC at the time of diagnosis (BCLC C or D) in more than 80% of patients [18] [20] [29] [30] . However, the performance status (PS) was better in Lascols study (France), with a PS = 0 or 1 in 59.8% of cases [30] , compared with a PS >1 in more than 90% in Côte d’Ivoire and Benin [18] [20] , and over 60% in Gambia [29] . In our study, the nodules were larger than 3 cm in almost 90% of cases, multiple in two-thirds of cases and portal vein invasion was noted in one-third of cases. These results were comparable to those of Lascols and Nikiéma (Burkina Faso) in terms of size and number of nodules. However, the proportion of vascular invasion was much higher in the Nikiéma study (56.8%), whereas it was almost the same (34.5%) in the Lascols one [15] [30] . This difference in portal vein invasion is probably linked to the fact that the study of Nikiéma was carried out in a radiology department.

We found an in-mortality rate of 20%. Other authors noted a considerably higher mortality close to 40 [18] [19] . This lower mortality observed in our work is probably related to the large number of patients who left against medical advice. Mortality was significantly associated with end-stage HCC in univariate analysis. Multivariate analysis found that length of stay < 5 days and hepatic encephalopathy were independent predictors of mortality. In the study of Natey in Ghana, hepatic encephalopathy was also identified as an independent predictor of mortality but the confidence interval was larger than in our study (OR = 5.66; CI 95: 1.10 – 29.2 vs OR = 3.63; CI 95: 1.49 – 8.85) [16] . However, this study was carried out on patients with HCC or cirrhosis without HCC, whereas our study concerned patients with HCC only.

One of the limitations of this study may be the fact that the patients were selected only in the Internal Medicine inpatient department could constitute a selection bias. However, very few cases are diagnosed as part of the follow-up of cirrhosis in our practice [20] .

HCC mainly affected young men infected with chronic viral hepatitis B. The high mortality rate of HCC was linked to the advanced stage of the disease at the time of diagnosis. Short length of stay and hepatic encephalopathy were independent predictors of mortality. Vigorous management of patients during the first few days of hospitalization, including early treatment and prevention of hepatic encephalopathy, could reduce in-hospital mortality.