Thrombocytopenia in Relation to Tumor Size in Patients with Hepatocellular Carcinoma

Carr, Brian I.; Guerra, Vito; Pančoška, Petr

doi:10.1159/000342431

Cited by 31 publications

(36 citation statements)

References 45 publications

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“…This is in line with other studies showing an association of thrombocytopenia and smaller tumor size when compared to patients with higher platelet counts [40][41][42]. Pathophysiologically, it was shown that platelets play a proinflammatory role in the course of chronic liver disease.…”

Section: Discussionsupporting

confidence: 91%

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

et al. 2018

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Background: Platelets have been reported to influence tumor biology and may promote metastasis. Traditionally, thrombocytopenia, a hallmark of cirrhosis, was associated with hepatocellular carcinoma (HCC) development. However, the impact of platelet count on outcome in patients with established HCC is not well studied. Methods: Outcomes of patients with cirrhosis diagnosed with HCC between 1995 and 2013 (derivation cohort) and 2000-2016 (validation cohort) who were not eligible for surgical treatment and did not receive antiplatelet therapy were retrospectively studied. Thrombocytopenia was defined as platelet count < 150 g/L. High mean platelet volume (MPV) was defined as ≥median value of the respective cohort (derivation cohort: ≥11 fL; validation cohort: ≥10.6 fL). Results: Among 626 patients with unresectable HCC, thrombocytopenia was present in 378 (60.4%) and was associated with favorable baseline tumor characteristics: lower diameter of the largest nodule (5.6 ± 3.2 vs. 7.6 ± . These results were confirmed in an independent external validation cohort of 525 patients with cirrhosis and HCC. Again, patients with thrombocytopenia and high MPV had significantly longer .2] months; p < 0.001). Conclusions: Thrombocytopenia and higher MPV are associated with better outcome in patients with advanced HCC. These findings may prompt further clinical research on additive antiplatelet therapy in the prevention and management of HCC.

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Section: Discussionsupporting

confidence: 91%

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

et al. 2018

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“…Thrombocytopenia is a risk for HCC in predisposed patients (3, 12–15), and associated with small HCC size (16, 17). We combined terciles II and III to create a manageable large tumor category for this analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Thrombocytopenia is a cirrhosis surrogate, an HCC risk factor, prognostic factor, and is associated with small HCCs (7–13, 16, 17). Non-cirrhotic HCCs can be large (22, 23, 24), and associated with thrombocytosis (25), which is a general sign of early malignancy (26).…”

Section: Discussionmentioning

confidence: 99%

Platelet-Related Phenotypic Patterns in Hepatocellular Carcinoma Patients

Carr

Lin

2014

Seminars in Oncology

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Background Small HCCs usually arise in cirrhosis, often with associated thrombocytopenia. Many large HCC patients have normal blood platelet counts. Aims To compare parameter and phenotype patterns of patients with small ≤3cm and larger HCCs. Methods Retrospective analysis was undertaken of a 4139 patient HCC database to compare patient demographics, liver and tumor characteristics associated with small and large size HCCs, especially with respect to platelet counts. Results Patients with larger HCCs had more tumor nodules and PVT positivity, and had higher blood AFP, bilirubin and platelet counts. In patients with larger tumors and normal platelets (43.7% of the cohort), tumors were larger and AFP levels were higher, with lower bilirubin and AST levels than in patients with larger tumors and thrombocytopenia (17.5%). A parsimonious multinomial regression model showed high Odds Ratio for AFP and platelets for tumors >3cm with PVT. Conclusions Platelet levels are associated with distinct large HCC phenotypes.

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“…Preoperative PLT was negatively associated with the amount of transfused platelets during surgery (coefficient -0.49; P < 0.001), during the first week after surgery (coefficient -0.55; P < 0.001), and between 1 and 2 weeks after surgery (coefficient -0.21; P < 0.001). Accordingly, the amount of transfused platelets during surgery, during the first week after surgery, and between 1 and 2 weeks after surgery was 0 (0-6), 9 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22), and 0 (0-0) units in the low platelet group and 0 (0-0), 0 (0-4), and 0 (0-0) units in the high platelet group, respectively, where 1 unit of apheresis platelets was considered to be equivalent to 6 units of platelets, as described previously. (22) Minimum PLT measured at each postoperative day during the first 2 weeks after transplantation was consistently <30 3 10 9 /L in median within the subgroup of recipients who underwent platelet transfusion on each corresponding day, indicating that platelet transfusion was performed according to our standardized protocol targeting PLT >30 3 10 9 /L (Supporting Fig.…”

Section: Association Between Perioperative Plt and Platelet Transfusionmentioning

confidence: 99%

“…(8) Another retrospective cohort study demonstrated that pretreatment PLT was positively associated with the probability of HCC recurrence after curative treatment. (9) The relationship between platelets and tumors is not a simple epiphenomenon resulting from tumor-induced thrombopoiesis, but rather a direct contribution of platelets to multiple steps in the cancer progression, including tumor cell angiogenesis, protection from immune attack, extravasation, and arrest within the vasculature.…”

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confidence: 99%

Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation

Han¹,

Lee

Yang

et al. 2017

Liver Transpl

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Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT £ 75 3 10 9 /L were matched with 97 of 119 patients who had preoperative PLT >75 3 10 9 /L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 3 10 9 /L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio [HR] 5 3.09; 95% confidence interval [CI], 1.86-5.14; P < 0.001) and multivariate analyses (HR 5 2.10; 95% CI, 1.23-3.60; P 5 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR 5 2.33; 95% CI, 1.36-4.01; P 5 0.002) and multivariate analyses (HR 5 1.90; 95% CI, 1.02-3.54; P 5 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-tolymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation.Liver Transplantation 24 44-55 2018 AASLD. Liver transplantation is a well-established therapeutic option for treatment of hepatocellular carcinoma (HCC), addressing both underlying liver disease, which is considered a premalignant lesion, and tumor burden. However, many recipients experience tumor recurrence and recurrent HCC is a major cause of death. Thus, better understanding of the contributing factors for HCC metastasis will help improve liver transplant outcome. (1,2) The platelet is the primary cell for hemostasis and tissue repair, (3) but extensive experimental evidence has also illuminated the involvement of platelets in tumor growth and metastasis. (4)(5)(6) Clinical evidence has demonstrated an association between higher platelet counts (PLTs) and shorter survival time and increased recurrence after treatment in various solid tumors. (7) In terms of HCC, a retrospective analysis using a large database of biopsy-proven HCC patients reported a positive Abbrevi...

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Thrombocytopenia in Relation to Tumor Size in Patients with Hepatocellular Carcinoma

Cited by 31 publications

References 45 publications

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma

Platelet-Related Phenotypic Patterns in Hepatocellular Carcinoma Patients

Risk of posttransplant hepatocellular carcinoma recurrence is greater in recipients with higher platelet counts in living donor liver transplantation

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