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

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The current approach to the management of gastric cancer relies on tumor-node and metastasis classification, which has been shown to have limitations. Molecular and genetic diagnoses are accurate and available but expensive. The modified Lauren classification has been proposed and is based on the tumor location, tumor histology, and clinical course. This classification is closely related to patient prognosis and could offer an accessible option for achieving individualised care in gastric cancer management. Aim - To map evidence on the patterns of gastric cancer by histopathological subtype and topographical subsite in sub-Saharan Africa (SSA). Methods: Primary studies on gastric cancer, particularly adenocarcinoma, between 2003 and 2024 in SSA were considered for inclusion in the study. A comprehensive search was performed via thePUBMED, Google Scholar, and Web of Science databases, which were subjected to a predeterminedprocess. Eligibilitywas assessed before inclusion, and inaccessible abstracts, full texts, studies in languages other than English, and studies in other countries not in Sub-Saharan Africa were excluded. Descriptive analysis was employed for data synthesis. Results After screening 214 studies from the databases yielded, 20 studies from nine SSA countries were included in the analysis. Most of the studies were retrospective. The intestinal histological subtype and the noncardiatopographical subsite were the most predominant. Two studies evaluated the associations of H.pylori with varioushistological subtypes. Three studies evaluated early-onset gastric cancer with a predominance of the intestinal histological subtype. Conclusion This review offers a comprehensive mapping of the literature on subsites and subtypes, with the intestinal subtype and noncardia subsite of gastric cancer being predominant in SSA. Research gaps are identified for future research in the region and include topographical subsites affected by the histological subtypes of gastric cancer and early-onset gastric cancer. Gastric cancer Sub Saharan Africa Gastric cancer histopathology Gastric cancer topography Early-onset gastric cancer Gastric cancer subsite Gastric cancer subtype Figures Figure 1 CORE TIP In the quest to achieve precision medicine and individualised patient care, it is vital to explore other accessible and viable options, such as the histological approach to the management of gastric cancer. The proposed modified Lauren classification relies on the gastric tumor histological subtype, topographical subsite, and clinical course and appears to correlate well with prognosis. Therefore, we undertook a scoping review to map the nature and patterns of the histological subtypes and topographical subsites of gastric cancer in SSA. The most common subtype was intestinal, and the predominant topographical subsite was the noncardia site. However, early-onset gastric cancer is of the intestinal subtype, which differs from that reported in most of the literature. Further research is needed to ensure the geographical diversity of studies and to explore these findings more thoroughly. INTRODUCTION Globally, gastric cancer is the fifth most common cancer, with a global incidence of 9.2 per 100,000 people [ 1 ]. The global age-standardised incidence of gastric cancer is 12.4 per 100,000 people, whereas the age-standardised mortality rate is 8.6 per 100,000 people. In sub-Saharan Africa, the incidence of gastric cancer ranges from 0.04 to 5.56 cases per 100,000 people, with a pooled incidence of 1.2 gastric cancer cases per 100,000 people [ 1 , 2 ]. Africa and Asia account for a disproportionately greater burden of cancer-related mortality than do high-incidence countries such as Europe and the Americas [ 1 , 2 ]. Approximately 20% of all gastric cancer cases and 90% of noncardia gastric cancer cases are attributed to Helicobacter pylori infection[ 3 , 4 ]. The prevalence of H. pylori infection in Africa is the highest globally, yet the prevalence of H. pylori -associated gastric cancer is low[ 5 ]. This enigma has been attributed to the relatively low virulence of Cag A-negative H. pylori strains in the African subpopulation[ 5 , 6 ], which is also thought to be due to chromosomal aberrations or different molecular pathways that occur in African gastric cancer patients[ 7 ]. The histomorphological classification of gastric cancer, the Lauren classification, and the WHO classification of gastric cancer are not related to the clinical course of gastric cancer[ 8 ]. The current approach to the management of gastric cancer relies on the tumor-node and metastasis classification, although this system has been shown to have limitations[ 8 ]. Precision medicine in gastric cancer management involves accurate diagnosis, accurate staging, minimally invasive surgery for early disease, and targeted therapies or immunomodulation for advanced disease.[ 9 ] The proposed molecular classification of gastric cancer, the cancer genome atlas (TCGA), offers accurate diagnosis; however, molecular and genetic studies are expensive. A modified Lauren classification has been proposed that incorporates both histopathological subtypes and topographical subsites of gastric cancer and appears to perform well as a prognostic tool for gastric cancer [ 10 – 12 ]. Owing to its easy accessibility, especially in low- and middle-income countries, there could be a role for the histological approach to therapy in gastric cancer[ 13 ]. Since access to genomic and molecular tumor characteristics may be out of reach for most patients in sub-Saharan Africa (SSA), the histopathological approach to therapy offers a cheap and accessible option for precision medicine in the treatment of patients with gastric cancer. This is only feasible when data from the region are available. The modified Lauren classification offers hope for a viable tool to appropriately manage and treat gastric cancer. Therefore, this study aims to map and evaluate the evidence available on the patterns of gastric cancer according to histopathological subtype and topographical subsite in sub-Saharan Africa. This information is crucial for planning primary and secondary prevention measures to manage gastric cancer in SSA. The information derived can also be used to establish targeted therapies for gastric cancer management in the region. METHODS Review question What is the evidence available on the patterns of gastric cancer by histopathological subtype and topographical subsite in SSA? Eligibility criteria We used the population concept and context framework to guide the review question and eligibility criteria. Inclusion criteria All four criteria below are necessary for inclusion in the study. Only studies that included adults diagnosed with gastric cancer were included. Only studies conducted in sub-Saharan Africa Only primary research studies that include randomised controlled trials, observational studies, systematic reviews, and quasi-experimental studies were performed after 2003. Studies that fulfil at least one criterion below: These subtypes include the topographical subsite and histopathological subtype of gastric cancer. Exclusion criteria Any one criterion fulfilled below will lead to exclusion from the study. Studies of other gastric tumors, neuroendocrine tumors, stromal tumors, and lymphomas. Studies that are published in languages other than English Studies with no available abstracts or full-text documents. In this study, a scoping review is defined as a study aimed at mapping the literature on a topic to identify key concepts, gaps in research, and sources of evidence to inform practice, research, and policy[ 14 ]. Search strategy The search strategy aimed to locate published studies, and the search terms used incorporated the population, concept and context framework. Population: ‘gastric cancer OR stomach cancer OR gastric adenocarcinoma OR stomach adenocarcinoma’ Concept: Histology OR histopathology OR endoscopic characteristics OR endoscopy OR morphology OR topography OR location Context: Sub Saharan Africa OR Individual Country names. The following electronic databases were searched: PUBMED, Web of Science, and Google Scholar. The search strategy, including all identified keywords and search terms, was adapted for each included database and/or information source. A full electronic search strategy for one database is included in the Table 1 below. Table 1 The full electronic search strategy conducted using PUBMED No MeSH Terms Date Accessed 1 ("gastric cancer" OR "stomach cancer" OR "gastric adenocarcinoma" OR "stomach adenocarcinoma") 9th September 2024 2 Histolog* OR histopatholog* OR patholog* OR topograph* OR microscop* OR macroscop* OR molecular pathology OR endoscopic characteristics OR endoscopy OR morphology OR location 9th September 2024 3 1 AND 2 9th September 2024 4. "Sub-Saharan Africa" OR "Africa South of the Sahara" OR Angola OR Benin OR Botswana OR "Burkina Faso" OR Burundi or Cameroon OR "Cape Verde" OR "Central African Republic" OR Chad OR Comoros OR Congo OR Brazzaville OR Cote d'Ivoire OR Djibouti OR "Equatorial Guinea" OR Eritrea OR Ethiopia OR Gabon OR Gambia OR Ghana OR "Guinea Bissau" OR Kenya OR Lesotho OR Liberia OR Madagascar OR Malawi OR Mali OR Mauritania OR Mauritius OR Mozambique OR Namibia OR Niger OR Nigeria OR Rwanda OR "Sao Tome e Principe" OR Senegal OR Seychelles OR "Sierra Leone" OR Somalia OR "South Africa" OR "South Sudan" OR Sudan OR Swaziland OR Tanzania OR Togo OR Uganda OR "Western Sahara" OR Zaire OR Zambia OR Zimbabwe OR "Bobo-Dioulasso" 9th September 2024 5 1 AND 2 9th September 2024 6 2003–2024 9th September 2024 Our review was conducted following the guidance provided by the JBI Scoping Review Methodology Group. All clinical studies published in English and studies published in the last 20 years (2003–2024) were included in the review. Study selection A pilot test of the search strategy was performed. Titles and abstracts were then screened by one independent reviewer against the eligibility criteria for the review. Studies that potentially fit the inclusion criteria were retrieved in full. The full texts of the selected studies were assessed in detail against the inclusion criteria by the reviewer. The reasons for excluding the studies that did not meet the eligibility criteria were recorded for all the retrieved articles. The results obtained from the search strategy are reported in the scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram below (Fig. 2)(Andrea C Tricco et al., 2018). Data extraction was carried out by the reviewer via a pretested extraction sheet in Google Forms, which was carefully piloted before use. The data extracted included the following: first author, year of publication, year of data collection, country of the study, and study design. For systematic reviews, the number of studies answering our review questions was added, and for primary studies, the number of patients used was sex of participants, early-onset gastric cancer, topographical subsites of gastric cancer, histopathological subtypes and associations of Helicobacter pylori with histopathological subtypes and topographical subsites. Data analysis and synthesis methods A descriptive analysis reporting the frequency, counts and proportions of studies and outcomes assessed was reported. The results are presented narratively and tabularly below to ensure classification of studies on the basis of methodological design and assessment on the basis of histopathological subtypes and topographical subsites of gastric cancer in Sub-Saharan Africa. RESULTS The process for inclusion of the final studies into the review is presented in Figure 1 below. Table 2 Characteristics of the Studies included in the Scoping review First Author Year of data collection Study design Population Sex (Male: Female) Mean age, Peak age Histological Subtype of Gastric Cancer Topographical Subsite of Gastric Cancer Intestinal Diffuse Mixed / Unclassified non cardia cardia Diffuse (Bang et al., 2020) 2013–2016 Cross-sectional 120 1.08:1 53.4y 60.00% 28.30% 5.00% (Ray-Offor and Obiorah, 2021) 2012–2021 Cross-sectional 17 1.1: 1 59y 78.60% 21.40% 58.80% 41.50% (Osinowo et al., 2023) 1991–2018 Retrospective 79* 1.8:1 56.4y/ 70 s 88.60% 11.40% 97.50% 2.50% (Udoh and Obaseki, 2012) 2005–2009 Retrospective 11* 1.7: 1 /60 s 100% 100% (Roberts et al., 2016) 2003–2011 Retrospective 97 1.13:1 57y 40.20% 52.6 7.20% (Abdulkareem et al., 2009) 1995–2006 Retrospective 79* 1.8:1 40 s 86% 10.50% 3.50% (Ahmed et al., 2011) 1995–2004 Retrospective 179 1.4:1 50 s 88.90% 7.70% 3.40% (Asombang et al., 2014) 2010–2012 Retrospective 50 1.63 :1 61.7y 78.60% 13.70% 7.80% (Benamro et al., 2017) 2009–2014 Retrospective 131 1.22: 1 60y 74.10% 25.90% 74.80% 18.80% 5.50% (Duduyemi et al., 2021) Missing Retrospective 91 1.33: 1 50 s 45% 51.60% 3.20% (Kayamba et al., 2024) 2015–2021 Retrospective 658* missing missing 71% 17% 12% (Kayamba, 2019) 2016–2018 Retrospective 92* 0.8:1 51 y 65% 35% (Mabula et al., 2012) 2007–2011 Retrospective 221* 2.9:1 52y 54.30% 25.30% 20.30% 69.30% 22.40% 8.20% (Martin et al., 2018) 2012–2016 Retrospective 229 1:1 58 y/50–60 48.90% 51.10% (Nizeyimana et al., 2021) 2016–2018 Retrospective 196 1:1 55y 55.90% 33.90% 10.20% (Kayamba et al., 2013) 2010–2012 Case Control 52 1.5:1 60 y 82% 17% 2% 23.50% 76.50% (Njenga et al., 2023) 2012–2019 Case Control 143 1.5:1 61y/50–60 61.50% 25.90% 7.70% 49.30% 50.70% (Mangaza et al., 2023) 2022 Case Series 3 2:1 28.3y 100% 100% (Kooffreh-Ada et al., 2023) Missing Case study 2 2:00 23.53y 100% 100% (Edwin et al., 2024) 2024 Case Study 1 1:00 30 s 100% 100% We have used * to represent studies which are subsets of a bigger population. All the studies included were from nine sub-Saharan African countries. The distribution of the studies included in the SSA is shown in Fig. 1 and Table 2 . Most of the studies included were retrospective cohort studies (n = 13), and the others were case studies (n = 3), cross-sectional studies (n = 2), or case‒control studies (n = 2). Half of the included studies evaluated both the topographical subsites and histopathological subtypes of gastric cancer, and the other half of the studies reported findings on only the histopathological subtype of gastric cancer (n = 6) or the topographical subsite of gastric cancer (n = 4). The sample sizes of the included studies ranged from 1 to 229 participants. Demographics The average age in most studies, excluding case reports, was 51–61 years, whereas the peak occurrence of gastric cancer in reported studies was 50–70 years of age. Most studies reported a male predominance of patients with gastric cancer (n = 13/15). Early-onset gastric cancer was evaluated in three studies, a case study and two retrospective studies comprising between 12% and 21% of the total patient population in the retrospective studies[ 15 – 17 ]. There was a male predominance in one retrospective study (2.6:1), and in the other, there was a slight female predominance (0.9:1). The case series consisted of two males and one female. The histological subtype was mainly the intestinal subtype, comprising all the cases in the case series and 82–90% of the population in the two retrospective studies. Topography Data on the topography of gastric cancer were noted in 14 studies, three of which were case studies. The noncardia subsite was observed in 71.2% of the non-case reports, the cardia subsite in 27.1%, and the remaining 1.5% had diffuse subsites. Most studies have shown that the noncardia subsite is the predominant site of gastric cancer. [ 18 – 25 ]Only two studies reported different trends, with more cardia subsites as the predominant location and a similar predilection for both cardia and noncardia gastric cancer subsites[ 17 , 26 ]. Histological subtype The Lauren classification was used to report the histopathological subtype in all studies. Data on the Lauren classification were available in sixteen studies. Excluding the case reports, the intestinal subtype was observed in 68.7%, the diffuse subtype was observed in 26.2%, and the mixed or unclassified subtype accounted for the remainder of the cases. The intestinal subtype was the predominant histological pattern in ten studies, whereas the diffuse subtype was predominant in only two studies. Helicobacter pylori The association of gastric cancer with H. pylori infection was evaluated in five studies; however, only two studies evaluated the association with the subtype of gastric cancer.[ 26 , 27 ] H. pylori -associated gastric cancers were predominantly intestinal in the histological subtype in 62.1% of patients, with the diffuse histological subtype accounting for 31.2% of H. pylori -positive gastric cancers. DISCUSSION This review aimed to evaluate the patterns of histopathological subtypes and topographical subsites of gastric cancer in SSA and yielded 20 studies for analysis. The studies were a mix of various methodological designs, ranging from case studies to case series, cross-sectional studies, case‒control studies, and retrospective studies. Approximately half of the studies originated from two countries, Zambia and Nigeria, and the other half originated from seven SSA countries. Most of the included studies were retrospective studies. This review illustrates the breadth of literature on the histopathological subtypes and topographical subsites of SSA. These areas of knowledge acquisition can be utilised for a future systematic review on the subject. However, the range of studies was limited to a few countries, with the majority of included studies originating from limited countries in the region. There are a small number of prospective studies in which a knowledge gap can be utilised for future studies. Early-onset gastric cancer Early-onset gastric cancer was reported in three studies, accounting for 12–21% of the gastric cancer population in the two retrospective studies, markedly higher than the global estimates of 10% of all gastric cancers[ 28 ]. Global studies have revealed a female preponderance with a diffuse histopathological subtype, yet our findings revealed a male preponderance with an intestinal histopathological subtype[ 28 ]. This finding calls for further studies to affirm and understand this phenomenon. Topography/Histopathology Globally, the noncardia subsite and intestinal subtypes of gastric cancer are the most predominant, which is not different from the findings of this review ([ 3 ]. The trends in the topographical subsite and histopathological subtypes of gastric cancer are noted to be changing globally, which can be attributed partly to changes in known risk factors, such as increasing obesity and the eradication of Helicobacter pylori . [ 3 ]. The findings of this review revealed a rising trend of cardia gastric cancer, accounting for 27.1% of cases, compared with the global average of 18% reported in prior reviews, which showed similar increasing trends, particularly in SSA[ 3 ]. This could be attributable to urbanisation, the increase in obesity, and the increasing prevalence of gastroesophageal reflux disease. No studies have evaluated the predilection for the histological subtype of gastric cancer for a topographical subsite. This information is crucial in the use of the modified Laurens classification for the prognostication and management of gastric cancer. Helicobacter pylori Only two studies have reported the association of H. pylori with histopathological subtypes of gastric cancer, yet reports have shown that the effects of H. pylori species on gastric cancer vary across regions due to differences in H. pylori variants and host factors. The contribution of Helicobacter pylori to intestinal gastric cancer in this review was lower than that reported in other studies; however, this phenomenon has been documented in earlier reports. In this review, only 62.1% of intestinal gastric cancer cases were attributed to H. pylori infection, which is lower than the up to 90% reported in other studies. [ 3 , 4 ]. These findings can enhance public health prevention and gastric cancer control efforts[ 16 , 17 ]. With the emergence of the modified Laurens classification as a viable tool for the prognostication of patients with gastric cancer, as well as an avenue to individualise care for patients with gastric cancer, evidence on the basis of the histopathological subtype and topographical subsite will be needed to develop gastric cancer management protocols[ 10 , 11 ]. This review has opened several key areas for future research in Sub-Saharan Africa, which include studies evaluating the prevalent subtypes and subsites in various regions, the need to evaluate the histological subtypes with the topographical subsites they have a predilection for, the associations of the topographical subsite and histopathological subtypes with H. pylori infection and the characteristics of early-onset gastric cancer in the region. Limitation: Owing to the breadth of data available, studies that could have been included in the study, especially gray literature, studies published before 2003 and studies with non-English and unavailable full-text articles, are likely to have been excluded. CONCLUSION The breadth and nature of the histopathological subtype and topographical subsite of gastric cancer in sub-Saharan Africa were evaluated in this review. Twenty studies revealed a preponderance of the noncardia subsite of gastric cancer and the intestinal histopathological subtype of gastric cancer. Early-onset gastric cancer was found to be of the intestinal subtype. Most of the included studies were retrospective, highlighting the need for more prospective studies. Owing to the limited number of eligible studies, there was a lack of geographical diversity of studies, with 50% of studies contributed by two countries. We did not find literature on the topographical predilection of the histological subsites of gastric cancer from the included studies. Further investigations are warranted to validate these findings in SSA. This review comprehensively demonstrates the breadth and nature of the evidence available on the histological subtype and topographical subsite of gastric cancer in SSA, the results of which can be utilised to plan further research investigations and guide policies on the control and management of gastric cancer in the region. Declarations Author contributions : Vivian V Akello, Moses Ocan, and Alison Kinengyere designed and performed the research. Vivian A. and Alison K analysed the data, and Vivian A, Alison K, and Moses O wrote the paper. The authors have read the PRISMA-ScR 2018 Checklist, and the manuscript was prepared and revised according to the PRISMA-ScR 2018 Checklist. Ethics, Consent to Participate, and Consent to Publish declarations: not applicable. Corresponding Author Vivian V Akello, MD, Gastrointestinal Surgery Unit, Directorate of Surgery, Mulago National Referral Hospital. [email protected] Acknowledgement I acknowledge Lucky Amaugo, who supervised and marked this paper as my dissertation, and my language editor, Curie, who edited the manuscript. References Bray, F., et al., Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024. 74 (3): p. 229-263. Ramadhar, A., et al., Gastric cancer in Sub-Saharan Africa - a systematic review of primary data. Ecancermedicalscience, 2024. 18 : p. 1680. Arnold, M., et al., Global burden of oesophageal and gastric cancer by histology and subsite in 2018. Gut, 2020. 69 (9): p. 1564-1571. Thrift, A.P. and T.H. Nguyen, Gastric Cancer Epidemiology. Gastrointest Endosc Clin N Am, 2021. 31 (3): p. 425-439. 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Cite Share Download PDF Status: Published Journal Publication published 13 Jan, 2026 Read the published version in BMC Cancer → Version 1 posted Editorial decision: Revision requested 16 Jul, 2025 Reviews received at journal 29 Jun, 2025 Reviews received at journal 22 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviews received at journal 22 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviewers agreed at journal 20 Jun, 2025 Reviewers invited by journal 13 Jun, 2025 Editor invited by journal 10 Apr, 2025 Editor assigned by journal 09 Apr, 2025 Submission checks completed at journal 09 Apr, 2025 First submitted to journal 07 Apr, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6396816","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":471762972,"identity":"f6eab82e-a584-4242-ace2-c9139eb65718","order_by":0,"name":"Vivian V Akello","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYFACNgaGBwUM9fuPNwA5BhZEakkwYGBsOHMApEWCFC03EkA8IrQYHD+W+CDBwIaZcebzqxt+FEgw8Ld3J+DXcibtsEGCQRobs3RO2c0eoMMkzpzdgFeLZEN6m0SCwWEeNumctBs8QC0GErkEtPQ/b/8B1CLBI3km7eYfYrTwS6QdA3r/sIGEBPux20TZwi/xLBnosLQEA54cttsyBhI8BP3Cxp9m+OFDhU2CAfvxZzff/LGR42/vxa8FCfAYgElilYMA+wNSVI+CUTAKRsEIAgDtGkTc62f0bAAAAABJRU5ErkJggg==","orcid":"","institution":"Mulago National Referral Hospital","correspondingAuthor":true,"prefix":"","firstName":"Vivian","middleName":"V","lastName":"Akello","suffix":""},{"id":471762973,"identity":"29a63ab2-61d9-497a-ad4f-872c4ca28a54","order_by":1,"name":"Alison A Kinengyere","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Alison","middleName":"A","lastName":"Kinengyere","suffix":""},{"id":471762974,"identity":"caf07dea-5b35-4e4b-84b5-d353af8a4156","order_by":2,"name":"Moses Ocan","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Moses","middleName":"","lastName":"Ocan","suffix":""}],"badges":[],"createdAt":"2025-04-07 18:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6396816/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6396816/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12885-026-15560-y","type":"published","date":"2026-01-13T16:28:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":85171384,"identity":"1839ade7-af08-459d-a398-1c01c2997d2f","added_by":"auto","created_at":"2025-06-23 05:43:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":63118,"visible":true,"origin":"","legend":"\u003cp\u003eFlow Diagram of Included Studies\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6396816/v1/e9d6150c819cc81df71be661.png"},{"id":100614538,"identity":"657dbf28-8065-4387-8ecc-5020cf4ce507","added_by":"auto","created_at":"2026-01-19 17:21:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":734847,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6396816/v1/6b17685c-5d2e-4ab2-8662-56983f02b181.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Histopathological subtypes and topographical subsites of gastric cancer in sub-Saharan Africa: a scoping review","fulltext":[{"header":"CORE TIP","content":"\u003cp\u003eIn the quest to achieve precision medicine and individualised patient care, it is vital to explore other accessible and viable options, such as the histological approach to the management of gastric cancer. The proposed modified Lauren classification relies on the gastric tumor histological subtype, topographical subsite, and clinical course and appears to correlate well with prognosis. Therefore, we undertook a scoping review to map the nature and patterns of the histological subtypes and topographical subsites of gastric cancer in SSA. The most common subtype was intestinal, and the predominant topographical subsite was the noncardia site. However, early-onset gastric cancer is of the intestinal subtype, which differs from that reported in most of the literature. Further research is needed to ensure the geographical diversity of studies and to explore these findings more thoroughly.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eGlobally, gastric cancer is the fifth most common cancer, with a global incidence of 9.2 per 100,000 people [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The global age-standardised incidence of gastric cancer is 12.4 per 100,000 people, whereas the age-standardised mortality rate is 8.6 per 100,000 people. In sub-Saharan Africa, the incidence of gastric cancer ranges from 0.04 to 5.56 cases per 100,000 people, with a pooled incidence of 1.2 gastric cancer cases per 100,000 people [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Africa and Asia account for a disproportionately greater burden of cancer-related mortality than do high-incidence countries such as Europe and the Americas [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eApproximately 20% of all gastric cancer cases and 90% of noncardia gastric cancer cases are attributed to \u003cem\u003eHelicobacter pylori\u003c/em\u003e infection[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The prevalence of \u003cem\u003eH. pylori\u003c/em\u003e infection in Africa is the highest globally, yet the prevalence of \u003cem\u003eH. pylori\u003c/em\u003e-associated gastric cancer is low[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This enigma has been attributed to the relatively low virulence of Cag A-negative \u003cem\u003eH. pylori\u003c/em\u003e strains in the African subpopulation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], which is also thought to be due to chromosomal aberrations or different molecular pathways that occur in African gastric cancer patients[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe histomorphological classification of gastric cancer, the Lauren classification, and the WHO classification of gastric cancer are not related to the clinical course of gastric cancer[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The current approach to the management of gastric cancer relies on the tumor-node and metastasis classification, although this system has been shown to have limitations[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrecision medicine in gastric cancer management involves accurate diagnosis, accurate staging, minimally invasive surgery for early disease, and targeted therapies or immunomodulation for advanced disease.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The proposed molecular classification of gastric cancer, the cancer genome atlas (TCGA), offers accurate diagnosis; however, molecular and genetic studies are expensive.\u003c/p\u003e \u003cp\u003eA modified Lauren classification has been proposed that incorporates both histopathological subtypes and topographical subsites of gastric cancer and appears to perform well as a prognostic tool for gastric cancer [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOwing to its easy accessibility, especially in low- and middle-income countries, there could be a role for the histological approach to therapy in gastric cancer[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Since access to genomic and molecular tumor characteristics may be out of reach for most patients in sub-Saharan Africa (SSA), the histopathological approach to therapy offers a cheap and accessible option for precision medicine in the treatment of patients with gastric cancer. This is only feasible when data from the region are available.\u003c/p\u003e \u003cp\u003eThe modified Lauren classification offers hope for a viable tool to appropriately manage and treat gastric cancer. Therefore, this study aims to map and evaluate the evidence available on the patterns of gastric cancer according to histopathological subtype and topographical subsite in sub-Saharan Africa. This information is crucial for planning primary and secondary prevention measures to manage gastric cancer in SSA. The information derived can also be used to establish targeted therapies for gastric cancer management in the region.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eReview question\u003c/p\u003e \u003cp\u003eWhat is the evidence available on the patterns of gastric cancer by histopathological subtype and topographical subsite in SSA?\u003c/p\u003e \u003cp\u003eEligibility criteria\u003c/p\u003e \u003cp\u003eWe used the population concept and context framework to guide the review question and eligibility criteria.\u003c/p\u003e \u003cp\u003eInclusion criteria\u003c/p\u003e \u003cp\u003eAll four criteria below are necessary for inclusion in the study.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eOnly studies that included adults diagnosed with gastric cancer were included.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOnly studies conducted in sub-Saharan Africa\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eOnly primary research studies that include randomised controlled trials, observational studies, systematic reviews, and quasi-experimental studies were performed after 2003.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies that fulfil at least one criterion below:\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eThese subtypes include the topographical subsite and histopathological subtype of gastric cancer.\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eExclusion criteria\u003c/p\u003e \u003cp\u003eAny one criterion fulfilled below will lead to exclusion from the study.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eStudies of other gastric tumors, neuroendocrine tumors, stromal tumors, and lymphomas.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies that are published in languages other than English\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStudies with no available abstracts or full-text documents.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eIn this study, a scoping review is defined as a study aimed at mapping the literature on a topic to identify key concepts, gaps in research, and sources of evidence to inform practice, research, and policy[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSearch strategy\u003c/p\u003e \u003cp\u003eThe search strategy aimed to locate published studies, and the search terms used incorporated the population, concept and context framework.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePopulation: \u0026lsquo;gastric cancer OR stomach cancer OR gastric adenocarcinoma OR stomach adenocarcinoma\u0026rsquo;\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eConcept: Histology OR histopathology OR endoscopic characteristics OR endoscopy OR morphology OR topography OR location\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eContext: Sub Saharan Africa OR Individual Country names.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe following electronic databases were searched: PUBMED, Web of Science, and Google Scholar. The search strategy, including all identified keywords and search terms, was adapted for each included database and/or information source. A full electronic search strategy for one database is included in the Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe full electronic search strategy conducted using PUBMED\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeSH Terms\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDate Accessed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(\"gastric cancer\" OR \"stomach cancer\" OR \"gastric adenocarcinoma\" OR \"stomach adenocarcinoma\")\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHistolog* OR histopatholog* OR patholog* OR topograph* OR microscop* OR macroscop* OR molecular pathology OR endoscopic characteristics OR endoscopy OR morphology OR location\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 AND 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\"Sub-Saharan Africa\" OR \"Africa South of the Sahara\" OR Angola OR Benin OR Botswana OR \"Burkina Faso\" OR Burundi or Cameroon OR \"Cape Verde\" OR \"Central African Republic\" OR Chad OR Comoros OR Congo OR Brazzaville OR Cote d'Ivoire OR Djibouti OR \"Equatorial Guinea\" OR Eritrea OR Ethiopia OR Gabon OR Gambia OR Ghana OR \"Guinea Bissau\" OR Kenya OR Lesotho OR Liberia OR Madagascar OR Malawi OR Mali OR Mauritania OR Mauritius OR Mozambique OR Namibia OR Niger OR Nigeria OR Rwanda OR \"Sao Tome e Principe\" OR Senegal OR Seychelles OR \"Sierra Leone\" OR Somalia OR \"South Africa\" OR \"South Sudan\" OR Sudan OR Swaziland OR Tanzania OR Togo OR Uganda OR \"Western Sahara\" OR Zaire OR Zambia OR Zimbabwe OR \"Bobo-Dioulasso\"\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 AND 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2003\u0026ndash;2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9th September 2024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOur review was conducted following the guidance provided by the JBI Scoping Review Methodology Group. All clinical studies published in English and studies published in the last 20 years (2003\u0026ndash;2024) were included in the review.\u003c/p\u003e \u003cp\u003eStudy selection\u003c/p\u003e \u003cp\u003eA pilot test of the search strategy was performed. Titles and abstracts were then screened by one independent reviewer against the eligibility criteria for the review. Studies that potentially fit the inclusion criteria were retrieved in full. The full texts of the selected studies were assessed in detail against the inclusion criteria by the reviewer. The reasons for excluding the studies that did not meet the eligibility criteria were recorded for all the retrieved articles. The results obtained from the search strategy are reported in the scoping review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram below (Fig.\u0026nbsp;2)(Andrea C Tricco et al., 2018).\u003c/p\u003e \u003cp\u003eData extraction was carried out by the reviewer via a pretested extraction sheet in Google Forms, which was carefully piloted before use. The data extracted included the following: first author, year of publication, year of data collection, country of the study, and study design. For systematic reviews, the number of studies answering our review questions was added, and for primary studies, the number of patients used was sex of participants, early-onset gastric cancer, topographical subsites of gastric cancer, histopathological subtypes and associations of \u003cem\u003eHelicobacter pylori\u003c/em\u003e with histopathological subtypes and topographical subsites.\u003c/p\u003e \u003cp\u003eData analysis and synthesis methods\u003c/p\u003e \u003cp\u003eA descriptive analysis reporting the frequency, counts and proportions of studies and outcomes assessed was reported. The results are presented narratively and tabularly below to ensure classification of studies on the basis of methodological design and assessment on the basis of histopathological subtypes and topographical subsites of gastric cancer in Sub-Saharan Africa.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe process for inclusion of the final studies into the review is presented in Figure 1 below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the Studies included in the Scoping review\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFirst Author\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eYear of data collection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStudy design\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex (Male: Female)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMean age, Peak age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c9\" namest=\"c7\"\u003e \u003cp\u003eHistological Subtype of Gastric Cancer\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c12\" namest=\"c10\"\u003e \u003cp\u003eTopographical Subsite of Gastric Cancer\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eIntestinal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDiffuse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eMixed / Unclassified\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003enon cardia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003ecardia\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eDiffuse\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Bang et al., 2020)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2013\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53.4y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e60.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e28.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Ray-Offor and Obiorah, 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCross-sectional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.1: 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e58.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e41.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Osinowo et al., 2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1991\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e56.4y/ 70 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e88.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e11.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e97.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e2.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Udoh and Obaseki, 2012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2005\u0026ndash;2009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.7: 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e/60 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Roberts et al., 2016)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2003\u0026ndash;2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e57y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e40.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e52.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Abdulkareem et al., 2009)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1995\u0026ndash;2006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.8:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e86%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Ahmed et al., 2011)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1995\u0026ndash;2004\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e88.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e7.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e3.40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Asombang et al., 2014)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2010\u0026ndash;2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.63 :1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61.7y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e78.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Benamro et al., 2017)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2009\u0026ndash;2014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.22: 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e74.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e74.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e18.80%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5.50%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Duduyemi et al., 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.33: 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e50 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e45%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51.60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Kayamba et al., 2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2015\u0026ndash;2021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e658*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003emissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003emissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Kayamba, 2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.8:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e51 y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e65%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Mabula et al., 2012)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2007\u0026ndash;2011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e221*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.9:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e54.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e20.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e69.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e22.40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e8.20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Martin et al., 2018)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u0026ndash;2016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e58 y/50\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e48.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e51.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Nizeyimana et al., 2021)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2016\u0026ndash;2018\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetrospective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e55y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e55.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e10.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Kayamba et al., 2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2010\u0026ndash;2012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e60 y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e17%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e76.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Njenga et al., 2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2012\u0026ndash;2019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase Control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.5:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e61y/50\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e61.50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e7.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e49.30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e50.70%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Mangaza et al., 2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase Series\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2:1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e28.3y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Kooffreh-Ada et al., 2023)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23.53y\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e(Edwin et al., 2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase Study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1:00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e30 s\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWe have used * to represent studies which are subsets of a bigger population.\u003c/p\u003e \u003cp\u003eAll the studies included were from nine sub-Saharan African countries. The distribution of the studies included in the SSA is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Most of the studies included were retrospective cohort studies (n\u0026thinsp;=\u0026thinsp;13), and the others were case studies (n\u0026thinsp;=\u0026thinsp;3), cross-sectional studies (n\u0026thinsp;=\u0026thinsp;2), or case‒control studies (n\u0026thinsp;=\u0026thinsp;2). Half of the included studies evaluated both the topographical subsites and histopathological subtypes of gastric cancer, and the other half of the studies reported findings on only the histopathological subtype of gastric cancer (n\u0026thinsp;=\u0026thinsp;6) or the topographical subsite of gastric cancer (n\u0026thinsp;=\u0026thinsp;4). The sample sizes of the included studies ranged from 1 to 229 participants.\u003c/p\u003e \u003cp\u003eDemographics\u003c/p\u003e \u003cp\u003eThe average age in most studies, excluding case reports, was 51\u0026ndash;61 years, whereas the peak occurrence of gastric cancer in reported studies was 50\u0026ndash;70 years of age. Most studies reported a male predominance of patients with gastric cancer (n\u0026thinsp;=\u0026thinsp;13/15).\u003c/p\u003e \u003cp\u003eEarly-onset gastric cancer was evaluated in three studies, a case study and two retrospective studies comprising between 12% and 21% of the total patient population in the retrospective studies[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. There was a male predominance in one retrospective study (2.6:1), and in the other, there was a slight female predominance (0.9:1). The case series consisted of two males and one female. The histological subtype was mainly the intestinal subtype, comprising all the cases in the case series and 82\u0026ndash;90% of the population in the two retrospective studies.\u003c/p\u003e \u003cp\u003eTopography\u003c/p\u003e \u003cp\u003eData on the topography of gastric cancer were noted in 14 studies, three of which were case studies. The noncardia subsite was observed in 71.2% of the non-case reports, the cardia subsite in 27.1%, and the remaining 1.5% had diffuse subsites.\u003c/p\u003e \u003cp\u003eMost studies have shown that the noncardia subsite is the predominant site of gastric cancer. [\u003cspan additionalcitationids=\"CR19 CR20 CR21 CR22 CR23 CR24\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]Only two studies reported different trends, with more cardia subsites as the predominant location and a similar predilection for both cardia and noncardia gastric cancer subsites[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHistological subtype\u003c/p\u003e \u003cp\u003eThe Lauren classification was used to report the histopathological subtype in all studies. Data on the Lauren classification were available in sixteen studies. Excluding the case reports, the intestinal subtype was observed in 68.7%, the diffuse subtype was observed in 26.2%, and the mixed or unclassified subtype accounted for the remainder of the cases. The intestinal subtype was the predominant histological pattern in ten studies, whereas the diffuse subtype was predominant in only two studies.\u003c/p\u003e\n\u003ch3\u003eHelicobacter pylori\u003c/h3\u003e\n\u003cp\u003eThe association of gastric cancer with \u003cem\u003eH. pylori\u003c/em\u003e infection was evaluated in five studies; however, only two studies evaluated the association with the subtype of gastric cancer.[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] \u003cem\u003eH. pylori\u003c/em\u003e-associated gastric cancers were predominantly intestinal in the histological subtype in 62.1% of patients, with the diffuse histological subtype accounting for 31.2% of \u003cem\u003eH. pylori\u003c/em\u003e-positive gastric cancers.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis review aimed to evaluate the patterns of histopathological subtypes and topographical subsites of gastric cancer in SSA and yielded 20 studies for analysis. The studies were a mix of various methodological designs, ranging from case studies to case series, cross-sectional studies, case‒control studies, and retrospective studies. Approximately half of the studies originated from two countries, Zambia and Nigeria, and the other half originated from seven SSA countries. Most of the included studies were retrospective studies. This review illustrates the breadth of literature on the histopathological subtypes and topographical subsites of SSA. These areas of knowledge acquisition can be utilised for a future systematic review on the subject. However, the range of studies was limited to a few countries, with the majority of included studies originating from limited countries in the region. There are a small number of prospective studies in which a knowledge gap can be utilised for future studies.\u003c/p\u003e \u003cp\u003eEarly-onset gastric cancer\u003c/p\u003e \u003cp\u003eEarly-onset gastric cancer was reported in three studies, accounting for 12\u0026ndash;21% of the gastric cancer population in the two retrospective studies, markedly higher than the global estimates of 10% of all gastric cancers[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Global studies have revealed a female preponderance with a diffuse histopathological subtype, yet our findings revealed a male preponderance with an intestinal histopathological subtype[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This finding calls for further studies to affirm and understand this phenomenon.\u003c/p\u003e \u003cp\u003eTopography/Histopathology\u003c/p\u003e \u003cp\u003eGlobally, the noncardia subsite and intestinal subtypes of gastric cancer are the most predominant, which is not different from the findings of this review ([\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe trends in the topographical subsite and histopathological subtypes of gastric cancer are noted to be changing globally, which can be attributed partly to changes in known risk factors, such as increasing obesity and the eradication of \u003cem\u003eHelicobacter pylori\u003c/em\u003e. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this review revealed a rising trend of cardia gastric cancer, accounting for 27.1% of cases, compared with the global average of 18% reported in prior reviews, which showed similar increasing trends, particularly in SSA[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This could be attributable to urbanisation, the increase in obesity, and the increasing prevalence of gastroesophageal reflux disease.\u003c/p\u003e \u003cp\u003eNo studies have evaluated the predilection for the histological subtype of gastric cancer for a topographical subsite. This information is crucial in the use of the modified Laurens classification for the prognostication and management of gastric cancer.\u003c/p\u003e\n\u003ch3\u003eHelicobacter pylori\u003c/h3\u003e\n\u003cp\u003eOnly two studies have reported the association of \u003cem\u003eH. pylori\u003c/em\u003e with histopathological subtypes of gastric cancer, yet reports have shown that the effects of \u003cem\u003eH. pylori\u003c/em\u003e species on gastric cancer vary across regions due to differences in \u003cem\u003eH. pylori\u003c/em\u003e variants and host factors.\u003c/p\u003e \u003cp\u003eThe contribution of \u003cem\u003eHelicobacter pylori\u003c/em\u003e to intestinal gastric cancer in this review was lower than that reported in other studies; however, this phenomenon has been documented in earlier reports. In this review, only 62.1% of intestinal gastric cancer cases were attributed to \u003cem\u003eH. pylori\u003c/em\u003e infection, which is lower than the up to 90% reported in other studies. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese findings can enhance public health prevention and gastric cancer control efforts[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the emergence of the modified Laurens classification as a viable tool for the prognostication of patients with gastric cancer, as well as an avenue to individualise care for patients with gastric cancer, evidence on the basis of the histopathological subtype and topographical subsite will be needed to develop gastric cancer management protocols[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis review has opened several key areas for future research in Sub-Saharan Africa, which include studies evaluating the prevalent subtypes and subsites in various regions, the need to evaluate the histological subtypes with the topographical subsites they have a predilection for, the associations of the topographical subsite and histopathological subtypes with \u003cem\u003eH. pylori\u003c/em\u003e infection and the characteristics of early-onset gastric cancer in the region.\u003c/p\u003e \u003cp\u003eLimitation:\u003c/p\u003e \u003cp\u003eOwing to the breadth of data available, studies that could have been included in the study, especially gray literature, studies published before 2003 and studies with non-English and unavailable full-text articles, are likely to have been excluded.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThe breadth and nature of the histopathological subtype and topographical subsite of gastric cancer in sub-Saharan Africa were evaluated in this review. Twenty studies revealed a preponderance of the noncardia subsite of gastric cancer and the intestinal histopathological subtype of gastric cancer. Early-onset gastric cancer was found to be of the intestinal subtype. Most of the included studies were retrospective, highlighting the need for more prospective studies. Owing to the limited number of eligible studies, there was a lack of geographical diversity of studies, with 50% of studies contributed by two countries. We did not find literature on the topographical predilection of the histological subsites of gastric cancer from the included studies. Further investigations are warranted to validate these findings in SSA.\u003c/p\u003e \u003cp\u003eThis review comprehensively demonstrates the breadth and nature of the evidence available on the histological subtype and topographical subsite of gastric cancer in SSA, the results of which can be utilised to plan further research investigations and guide policies on the control and management of gastric cancer in the region.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e: Vivian V Akello, Moses Ocan, and Alison Kinengyere designed and performed the research. Vivian A. and Alison K analysed the data, and Vivian A, Alison K, and Moses O wrote the paper.\u003c/p\u003e\n\u003cp\u003eThe authors have read the PRISMA-ScR 2018 Checklist, and the manuscript was prepared and revised according to the PRISMA-ScR 2018 Checklist.\u003c/p\u003e\n\u003cp\u003eEthics, Consent to Participate, and Consent to Publish declarations: not applicable.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eCorresponding Author\u003c/strong\u003e \u003cp\u003eVivian V Akello, MD, Gastrointestinal Surgery Unit, Directorate of Surgery, Mulago National Referral Hospital. [email protected]\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eI acknowledge Lucky Amaugo, who supervised and marked this paper as my dissertation, and my language editor, Curie, who edited the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBray, F., et al., \u003cem\u003eGlobal cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.\u003c/em\u003e CA Cancer J Clin, 2024. \u003cstrong\u003e74\u003c/strong\u003e(3): p. 229-263.\u003c/li\u003e\n\u003cli\u003eRamadhar, A., et al., \u003cem\u003eGastric cancer in Sub-Saharan Africa - a systematic review of primary data.\u003c/em\u003e Ecancermedicalscience, 2024. \u003cstrong\u003e18\u003c/strong\u003e: p. 1680.\u003c/li\u003e\n\u003cli\u003eArnold, M., et al., \u003cem\u003eGlobal burden of oesophageal and gastric cancer by histology and subsite in 2018.\u003c/em\u003e Gut, 2020. \u003cstrong\u003e69\u003c/strong\u003e(9): p. 1564-1571.\u003c/li\u003e\n\u003cli\u003eThrift, A.P. and T.H. Nguyen, \u003cem\u003eGastric Cancer Epidemiology.\u003c/em\u003e Gastrointest Endosc Clin N Am, 2021. \u003cstrong\u003e31\u003c/strong\u003e(3): p. 425-439.\u003c/li\u003e\n\u003cli\u003eHooi, J.K.Y., et al.., \u003cem\u003eGlobal Prevalence of Helicobacter Pylori Infection: Systematic Review and Meta-Analysis.\u003c/em\u003e Gastroenterology, 2017. \u003cstrong\u003e153\u003c/strong\u003e(2): p. 420-429.\u003c/li\u003e\n\u003cli\u003eJ. A. Louw et al., \u003cem\u003eThe Relationship Between Helicobacter Pylori Infection, the Virulence Genotypes of the Infecting Strain and Gastric Cancer in the African Setting \u003c/em\u003eHelicobacter, 2001. \u003cstrong\u003e6\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eTineke E Buffart, M.L., Nicole CT van Grieken, Marianne Tijssen, Beatriz Carvalho, Bauke Ylstra, Heike Grabsch, Chris JJ Mulder, Cornelis JH van de Veld, Schalk W van der Merwe, Gerrit A Meijer, \u003cem\u003eGastric cancers of Western European and African patients show different patterns of genomic instability \u003c/em\u003eBMC Medical Genomics 2011. \u003cstrong\u003e4\u003c/strong\u003e(7).\u003c/li\u003e\n\u003cli\u003eJeon, J. and J.H. Cheong, \u003cem\u003eClinical Implementation of Precision Medicine in Gastric Cancer.\u003c/em\u003e J Gastric Cancer, 2019. \u003cstrong\u003e19\u003c/strong\u003e(3): p. 235-253.\u003c/li\u003e\n\u003cli\u003eWang, Y., et al., \u003cem\u003eProgress of Gastric Cancer Surgery in the era of Precision Medicine.\u003c/em\u003e Int J Biol Sci, 2021. \u003cstrong\u003e17\u003c/strong\u003e(4): p. 1041-1049.\u003c/li\u003e\n\u003cli\u003eShah, M.A., et al., \u003cem\u003eMolecular classification of gastric cancer: a new paradigm.\u003c/em\u003e Clin Cancer Res, 2011. \u003cstrong\u003e17\u003c/strong\u003e(9): p. 2693-701.\u003c/li\u003e\n\u003cli\u003eZhao, L.Y., et al.., \u003cem\u003eSuperiority of Tumor Location-Modified Lauren Classification System for Gastric Cancer: A Multi-Institutional Validation Analysis.\u003c/em\u003e Ann Surg Oncol, 2018. \u003cstrong\u003e25\u003c/strong\u003e(11): p. 3257-3263.\u003c/li\u003e\n\u003cli\u003eNing, F.L., et al., \u003cem\u003ePrognostic value of modified Lauren classification in gastric cancer.\u003c/em\u003e World J Gastrointest Oncol, 2021. \u003cstrong\u003e13\u003c/strong\u003e(9): p. 1184-1195.\u003c/li\u003e\n\u003cli\u003eIna Valeria Zurlo, M.B., Antonia Strippoli , Maria Alessandra Calegari ,Armando Orlandi , Alessandra Cassano, Mariantonietta Di Salvatore , Giovanna Garufi ,Emilio Bria , Giampaolo Tortora, Carlo Barone Carmelo Pozzo., \u003cem\u003eTreatment of Locally Advanced Gastric Cancer (LAGC): Back to Lauren\u0026rsquo;s Classification in Pan\u0026ndash;Cancer Analysis Era?\u003c/em\u003e Cancers, 2020. \u003cstrong\u003e12\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eDaudt, H.M., v.M. Catherine, and J.S. Samantha, \u003cem\u003eEnhancing the scoping study methodology: a large, interprofessional team\u0026rsquo;s experience with Arksey and O\u0026rsquo;Malley\u0026rsquo;s framework \u003c/em\u003eMC Medical Research Methodolog, 2013. \u003cstrong\u003e13\u003c/strong\u003e(48).\u003c/li\u003e\n\u003cli\u003eMangaza, A., et al., \u003cem\u003eGastric cancer for young adults: Case series of three cases.\u003c/em\u003e International Journal of Surgery Case Reports, 2023. \u003cstrong\u003e110\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eRoberts, R., et al.., \u003cem\u003eA morphological and immunohistochemical evaluation of gastric carcinoma in the Western Cape province of South Africa.\u003c/em\u003e South African Journal of Surgery, 2016. \u003cstrong\u003e54\u003c/strong\u003e(1): p. 15-21.\u003c/li\u003e\n\u003cli\u003eKayamba, V., et al., \u003cem\u003eGastric adenocarcinoma in Zambia: A case‒control study of HIV, lifestyle risk factors and biomarkers of pathogenesis.\u003c/em\u003e Samj South African Medical Journal, 2013. \u003cstrong\u003e103\u003c/strong\u003e(4): p. 255-259.\u003c/li\u003e\n\u003cli\u003eMabula, J.B., et al., \u003cem\u003eGastric cancer at a university teaching hospital in northwestern Tanzania: a retrospective review of 232 cases.\u003c/em\u003e World J Surg Oncol, 2012. \u003cstrong\u003e10\u003c/strong\u003e: p. 257.\u003c/li\u003e\n\u003cli\u003eKayamba, V. and P. Kelly,\u003cem\u003e Delayed Referral for diagnostic endoscopy is a contributing factor for late gastric cancer diagnosis in Zambia.\u003c/em\u003e Health Press, 2019. \u003cstrong\u003e3\u003c/strong\u003e(2): p. 14-19.\u003c/li\u003e\n\u003cli\u003eKayamba, V., M. Mubbunu, and P. Kelly, \u003cem\u003eEndoscopic diagnosis of gastric and oesophageal cancer in Lusaka, Zambia: a retrospective analysis.\u003c/em\u003e Bmc Gastroenterology, 2024. \u003cstrong\u003e24\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eBenamro, F., et al.., \u003cem\u003eThe spectrum of gastric cancer as seen in a large quaternary hospital in KwaZulu-Natal, South Africa.\u003c/em\u003e Samj South African Medical Journal, 2017. \u003cstrong\u003e107\u003c/strong\u003e(2): p. 130-133.\u003c/li\u003e\n\u003cli\u003eAhmed, A., et al.., \u003cem\u003eManagement and outcome of gastric carcinoma in Zaria, Nigeria.\u003c/em\u003e Afr Health Sci, 2011. \u003cstrong\u003e11\u003c/strong\u003e(3): p. 353-61.\u003c/li\u003e\n\u003cli\u003eRay-Offor, E. and C.C. Obiorah, \u003cem\u003eTopography and Morphology of Gastric Cancer in Nigeria: A Dual Institution Review of 622 Upper Gastrointestinal Endoscopies.\u003c/em\u003e Cureus Journal of Medical Science, 2021. \u003cstrong\u003e13\u003c/strong\u003e(4).\u003c/li\u003e\n\u003cli\u003eOsinowo, A.O., et al., \u003cem\u003eClinicopathological Features and Treatment Outcome of Patients with Gastric Cancer in Lagos: Is the Outlook Getting Better?\u003c/em\u003e J West Afr Coll Surg, 2023. \u003cstrong\u003e13\u003c/strong\u003e(1): p. 67-73.\u003c/li\u003e\n\u003cli\u003eBang, G.A., et al.., \u003cem\u003eClinical epidemiology and mortality risk factors for gastric cancer in a sub-Saharan African setting: a retrospective analysis of 120 cases in Yaounde (Cameroon).\u003c/em\u003e Pan African Medical Journal, 2020. \u003cstrong\u003e37\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eNjenga, P.W., \u003cem\u003eAssociation of helicobacter pylori caga and vaca genotypes with gastric adenocarcinoma in Kenya.\u003c/em\u003e 2021.\u003c/li\u003e\n\u003cli\u003eNizeyimana, T., et al., \u003cem\u003eOccurrence of Helicobacter Pylori in Specimens of Chronic Gastritis and Gastric Adenocarcinoma Patients: A Retrospective Study at University Teaching Hospital, Kigali, Rwanda.\u003c/em\u003e East Afr Health Res J, 2021. \u003cstrong\u003e5\u003c/strong\u003e(2): p. 159-163.\u003c/li\u003e\n\u003cli\u003eMazurek, M., et al.., \u003cem\u003eGastric Cancer: An Up-to-Date Review with New Insights into Early-Onset Gastric Cancer.\u003c/em\u003e Cancers (Basel), 2024. \u003cstrong\u003e16\u003c/strong\u003e(18).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastric cancer, Sub Saharan Africa, Gastric cancer histopathology, Gastric cancer topography, Early-onset gastric cancer, Gastric cancer subsite, Gastric cancer subtype","lastPublishedDoi":"10.21203/rs.3.rs-6396816/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6396816/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrecision medicine in gastric cancer management involves accurate diagnosis, accurate staging, minimally invasive surgery for early disease, and targeted therapies or immunomodulation for advanced disease.\u003c/p\u003e\n\u003cp\u003eThe current approach to the management of gastric cancer relies on tumor-node and metastasis classification, which has been shown to have limitations. Molecular and genetic diagnoses are accurate and available but expensive.\u003c/p\u003e\n\u003cp\u003eThe modified Lauren classification has been proposed and is based on the tumor location, tumor histology, and clinical course. This classification is closely related to patient prognosis and could offer an accessible option for achieving individualised care in gastric cancer management.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim \u003c/strong\u003e- To map evidence on the patterns of gastric cancer by histopathological subtype and topographical subsite in sub-Saharan Africa (SSA).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePrimary studies on gastric cancer, particularly adenocarcinoma, between 2003 and 2024 in SSA were considered for inclusion in the study. A comprehensive search was performed via thePUBMED, Google Scholar, and Web of Science databases, which were subjected to a predeterminedprocess. Eligibilitywas assessed before inclusion, and inaccessible abstracts, full texts, studies in languages other than English, and studies in other countries not in Sub-Saharan Africa were excluded. Descriptive analysis was employed for data synthesis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter screening 214 studies from the databases yielded, 20 studies from nine SSA countries were included in the analysis. Most of the studies were retrospective. The intestinal histological subtype and the noncardiatopographical subsite were the most predominant. Two studies evaluated the associations of \u003cem\u003eH.pylori\u003c/em\u003e with varioushistological subtypes. Three studies evaluated early-onset gastric cancer with a predominance of the intestinal histological subtype.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis review offers a comprehensive mapping of the literature on subsites and subtypes, with the intestinal subtype and noncardia subsite of gastric cancer being predominant in SSA. Research gaps are identified for future research in the region and include topographical subsites affected by the histological subtypes of gastric cancer and early-onset gastric cancer.\u003c/p\u003e","manuscriptTitle":"Histopathological subtypes and topographical subsites of gastric cancer in sub-Saharan Africa: a scoping review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-23 05:43:09","doi":"10.21203/rs.3.rs-6396816/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-16T06:45:57+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-29T17:56:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T18:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"155320004946047558556453371465696572321","date":"2025-06-22T16:53:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-22T12:20:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132094189250708048517088463636138104900","date":"2025-06-22T09:53:08+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"280196304799220070610546829284841490774","date":"2025-06-21T15:33:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"28461712661804602828797070020819362231","date":"2025-06-21T13:36:56+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87614021124036358313886669799091362672","date":"2025-06-20T07:10:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T08:49:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-10T05:21:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-09T22:23:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-09T22:21:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-04-07T18:31:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"50dff0f5-8b3b-40be-a957-71367a7d3097","owner":[],"postedDate":"June 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-01-19T16:46:29+00:00","versionOfRecord":{"articleIdentity":"rs-6396816","link":"https://doi.org/10.1186/s12885-026-15560-y","journal":{"identity":"bmc-cancer","isVorOnly":false,"title":"BMC Cancer"},"publishedOn":"2026-01-13 16:28:48","publishedOnDateReadable":"January 13th, 2026"},"versionCreatedAt":"2025-06-23 05:43:09","video":"","vorDoi":"10.1186/s12885-026-15560-y","vorDoiUrl":"https://doi.org/10.1186/s12885-026-15560-y","workflowStages":[]},"version":"v1","identity":"rs-6396816","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6396816","identity":"rs-6396816","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}