Background: International recommendations for the management of hepatocellular carcinoma (HCC) are often difficult to apply in low-resource settings. This study aimed to describe the epidemiological, clinical, diagnostic and therapeutic characteristics of HCC patients managed at Analankininina University Hospital in Toamasina, Madagascar.

Methods: This retrospective, descriptive cross-sectional study was conducted from January 1, 2017 to December 31, 2021. Diagnosis of HCC was based on histological confirmation or non-invasive radiological criteria (arterial enhancement with washout on dynamic imaging) and/or elevated alpha-fetoprotein >500 ng/ml in cirrhotic patients. Serological, radiological and therapeutic data were analysed. The Child–Pugh score was used to assess liver function and the Barcelona Clinic Liver Cancer (BCLC) classification was used for staging and therapeutic guidance. Alcoholism was defined as documented chronic excessive alcohol consumption recorded in medical files.

Results: Forty-three patients were included. Mean age was 52.57 ± 19.74 years. The male-to-female ratio was 2.31. Most patients were diagnosed at advanced stages (BCLC C/D: 39/43). Alpha-fetoprotein was >500 ng/ml in 33/43 patients. Liver ultrasound was performed in all cases, CT scan in 9/43 and histological confirmation was obtained in 9/43. Symptomatic palliative care was administered in 33/43 patients.

Conclusion: HCC is frequently diagnosed at an advanced stage in our setting, limiting curative treatment options. Limited access to dynamic imaging, histopathology and systemic therapies contributes to suboptimal management. Strengthening hepatitis B virus birth dose vaccination, early screening of at-risk populations and improving access to diagnostic tools are essential priorities.