Prognostic significance of platelet count in HCC patients adjusted for surrogate parameters of portal hypertension

Introduction The treatment of hepatocellular carcinoma (HCC) is often complicated by comorbidities arising from portal hypertension, such as ascites and variceal bleeding. Recent studies have demonstrated a paradoxical relationship between low platelet count, a well-established surrogate marker of portal hypertension, and improved survival in advanced HCC patients. Given this ambivalent association, it is crucial to comprehensively evaluate the role of platelet count in determining patient survival, considering its dual significance as a marker of both impaired liver function and portal hypertension. This assessment should be conducted through a multivariate analysis that encompasses independent markers of portal hypertension.

Material and Methods To address this, we conducted a retrospective analysis of data from 1,117 consecutive patients diagnosed with HCC between 2006 and 2022, obtained from three medical centers (Munich, Vienna, Mannheim). A multivariate analysis, encompassing various clinical variables including variceal status and spleen size, was performed to assess the prognostic importance of platelet count, independent of its role as a marker of portal hypertension.

Results The multivariate analysis revealed that low platelet counts independently predict survival (OR 1.003; 95%CI 1.001-1.005; p=0.014), irrespective of spleen size and variceal status.

Summary Our findings validate prior studies suggesting that platelets may exert a detrimental influence on patient outcomes by interacting with the tumor microenvironment, potentially promoting tumor proliferation or metastasis. This data warrants further investigations of the molecular pathways underlying this phenomenon.

Publication History

Article published online:
13 May 2024