The Prognostic Value of Platelet Count in Patients With Hepatocellular Carcinoma
Open Access
- 1 September 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Medicine
- Vol. 94 (37), e1431
- https://doi.org/10.1097/md.0000000000001431
Abstract
Thrombocytopenia has been acknowledged to be a crucial risk factor for cirrhosis formation and hepatocarcinogenesis in chronic liver diseases. However, to date, the association between platelet count (PLT) and the prognosis of hepatocellular carcinoma (HCC) remains inconsistent and controversial. The aim of the present study was to determine whether PLT could be used as a useful predictor of survival in patients with HCC. We performed systematic review in online databases, including PubMed, EmBase, and Web of Science, from inception until 2014. Studies were included if a statistical relationship was investigated between PLT and survival for HCC, and hazard ratio (HR) and 95% confidence intervals (CIs) for overall survival (OS) or recurrence-free survival (RFS) were provided. The quality of each included study was assessed by Newcastle–Ottawa scale score. To synthesize these studies, a random-effects model or a fixed-effects model was applied as appropriate. Then, we calculated heterogeneity, performed sensitivity analysis, tested publication bias, and did subgrouped and meta-regression analysis. Finally, we identified 33 eligible articles (published from 1998 to 2014) involved 5545 patients by retrieval. A low level of preoperative PLT was found to be significantly associated with a poor survival of HCC. Irrespective of the therapy used, the pooled HRs for OS and RFS were 1.41 (95% CI, 1.14–1.75) and 1.44 (95% CI, 1.13–1.83), respectively. Specifically, in patients who underwent liver resection, the pooled HRs for OS and RFS were 1.67 (95% CI, 1.22–2.27) and 1.44 (95% CI, 1.04–1.99), respectively. Furthermore, patients with preoperative thrombocytopenia (PLT < 100 × 109/L) had a worse OS (HR: 1.73, 95% CI, 1.29–2.32) and RFS (HR: 1.57, 95% CI, 1.31–1.87) in comparison with patients without thrombocytopenia. All our findings showed no significant changes due to the removal of any study or the use of an opposite-effects model, and there was no significant publication bias. The limitations of this meat-analysis were nonuniform cut-off values of PLT, high between-study heterogeneities, potential confounders, and a bias of publication year. A low preoperative PLT level results in an unfavorable outcome in HCC. PLT is a simple, inexpensive, and useful predictor of survival in patients with HCC.Keywords
This publication has 74 references indexed in Scilit:
- Rising Incidence of Primary Liver Cancer in Brunei DarussalamAsian Pacific Journal of Cancer Prevention, 2013
- Challenges in cancer vaccine development for hepatocellular carcinomaJournal of Hepatology, 2013
- Clinical outcome in patients with hepatocellular carcinoma after living-donor liver transplantationWorld Journal of Gastroenterology, 2013
- Accumulation of platelets in the liver may be an important contributory factor to thrombocytopenia and liver fibrosis in chronic hepatitis CThe Esophagus, 2012
- Resection of hepatocellular cancer ≤2 cm: Results from two Western centersHepatology, 2012
- Prognostic factors and outcomes of patients with hepatocellular carcinoma in non-cirrhotic liverScandinavian Journal of Gastroenterology, 2012
- Prospective study on the survival of HCC patients treated with transcatheter arterial lipiodol chemoembolization.Asian Pacific Journal of Cancer Prevention, 2012
- Epidemiology of chronic hepatitis B virus infection, hepatocellular carcinoma, and hepatitis B virus-induced hepatocellular carcinomaPathologie Biologie, 2010
- Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008International Journal of Cancer, 2010
- Semiannual surveillance is superior to annual surveillance for the detection of early hepatocellular carcinoma and patient survivalJournal of Hepatology, 2010