{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:55:50Z","timestamp":1793382950645,"version":"4.5.0"},"reference-count":39,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["-"],"award-info":[{"award-number":["-"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>The prognostic role of platelet count in hepatocellular carcinoma (HCC) remains unclear, and in fact both thrombocytopenia and thrombocytosis are reported as predictors of unfavourable outcomes. This study aimed to clarify the prognostic value of preoperative platelet count in potentially resectable HCC. We retrospectively reviewed 128 patients who underwent hepatic resection for HCC at a tertiary academic centre (2007\u20132019). Patient data were modelled by regression analysis, and platelet count was treated as a continuous variable. 89 patients had BCLC 0\/A tumours and 39 had BCLC B tumours. Platelet count was higher in patients with larger tumours and lower in patients with higher MELD scores, advanced fibrosis, and portal hypertension (p &lt; 0.001 for all listed variables). After adjusting for BCLC stage and tumour diameter, low platelet count associated with reduced overall survival (hazard ratio 1.25 per 50\/nL decrease in platelet count, 95% confidence interval (CI) 1.02\u20131.53, p = 0.034) and increased perioperative mortality (odds ratio 1.96 per 50\/nL decrease in platelet count, 95% CI 1.19\u20133.53, p = 0.014). Overall, low platelet count correlates with increased liver disease severity, inferior survival, and excess perioperative mortality in resectable HCC. These insights might be applied in clinical practice to better select patients for resection.<\/jats:p>","DOI":"10.3390\/curroncol29030124","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T20:09:57Z","timestamp":1646078997000},"page":"1475-1487","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Low Platelet Count Predicts Reduced Survival in Potentially Resectable Hepatocellular Carcinoma"],"prefix":"10.3390","volume":"29","author":[{"given":"Christopher","family":"Schrecker","sequence":"first","affiliation":[{"name":"Department of Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Waidmann","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanan","family":"El Youzouri","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg","family":"Trojan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas Anton","family":"Schnitzbauer","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolf Otto","family":"Bechstein","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Zeuzem","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"394","DOI":"10.3322\/caac.21492","article-title":"Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"68","author":"Bray","year":"2018","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.1056\/NEJMra1713263","article-title":"Hepatocellular Carcinoma","volume":"380","author":"Villanueva","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1053\/j.gastro.2018.01.064","article-title":"Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis","volume":"154","author":"Tzartzeva","year":"2018","journal-title":"Gastroenterology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1055\/s-2007-1007122","article-title":"Prognosis of hepatocellular carcinoma: The BCLC staging classification","volume":"19","author":"Llovet","year":"1999","journal-title":"Semin. Liver Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma","volume":"69","author":"Galle","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1002\/hep.29086","article-title":"AASLD guidelines for the treatment of hepatocellular carcinoma","volume":"67","author":"Heimbach","year":"2018","journal-title":"Hepatology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1038\/s41577-019-0202-z","article-title":"Patrolling the vascular borders: Platelets in immunity to infection and cancer","volume":"19","author":"Gaertner","year":"2019","journal-title":"Nat. Rev. Immunol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1016\/j.ccell.2018.03.002","article-title":"The Platelet Lifeline to Cancer: Challenges and Opportunities","volume":"33","author":"Haemmerle","year":"2018","journal-title":"Cancer Cell"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1182\/blood-2006-10-053736","article-title":"Trousseau\u2019s syndrome: Multiple definitions and multiple mechanisms","volume":"110","author":"Varki","year":"2007","journal-title":"Blood"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1056\/NEJMoa1110352","article-title":"Paraneoplastic thrombocytosis in ovarian cancer","volume":"366","author":"Stone","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1016\/j.ccr.2011.09.009","article-title":"Direct signaling between platelets and cancer cells induces an epithelial-mesenchymal-like transition and promotes metastasis","volume":"20","author":"Labelle","year":"2011","journal-title":"Cancer Cell"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"eaai7911","DOI":"10.1126\/sciimmunol.aai7911","article-title":"Platelets subvert T cell immunity against cancer via GARP-TGF\u03b2 axis","volume":"2","author":"Rachidi","year":"2017","journal-title":"Sci. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1038\/s41591-019-0379-5","article-title":"Platelet GPIb\u03b1 is a mediator and potential interventional target for NASH and subsequent liver cancer","volume":"25","author":"Malehmir","year":"2019","journal-title":"Nat. Med."},{"key":"ref_14","first-page":"1295","article-title":"Lysis of tumor cells by natural killer cells in mice is impeded by platelets","volume":"59","author":"Nieswandt","year":"1999","journal-title":"Cancer Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.1016\/S0140-6736(20)30366-4","article-title":"Cancer prevention with aspirin in hereditary colorectal cancer (Lynch syndrome), 10-year follow-up and registry-based 20-year data in the CAPP2 study: A double-blind, randomised, placebo-controlled trial","volume":"395","author":"Burn","year":"2020","journal-title":"Lancet"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1056\/NEJMoa1912035","article-title":"Association of Aspirin with Hepatocellular Carcinoma and Liver-Related Mortality","volume":"382","author":"Simon","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1172\/JCI105380","article-title":"Pooling of platelets in the spleen: Role in the pathogenesis of \u201chypersplenic\u201d thrombocytopenia","volume":"45","author":"Aster","year":"1966","journal-title":"J. Clin. Investig."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.jhepr.2019.10.001","article-title":"Platelets in chronic liver disease, from bench to bedside","volume":"1","author":"Ramadori","year":"2019","journal-title":"JHEP Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"9142672","DOI":"10.1155\/2018\/9142672","article-title":"Deciphering Platelet Kinetics in Diagnostic and Prognostic Evaluation of Hepatocellular Carcinoma","volume":"2018","author":"Aryal","year":"2018","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1056\/NEJM199603143341104","article-title":"Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis","volume":"334","author":"Mazzaferro","year":"1996","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/S1470-2045(08)70284-5","article-title":"Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: A retrospective, exploratory analysis","volume":"10","author":"Mazzaferro","year":"2009","journal-title":"Lancet Oncol."},{"key":"ref_22","first-page":"1","article-title":"Surgery and portal hypertension","volume":"1","author":"Child","year":"1964","journal-title":"Major Probl. Clin. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/S0140-6736(16)32453-9","article-title":"Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): A randomised, double-blind, placebo-controlled, phase 3 trial","volume":"389","author":"Bruix","year":"2017","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1016\/S0140-6736(18)30207-1","article-title":"Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: A randomised phase 3 non-inferiority trial","volume":"391","author":"Kudo","year":"2018","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/jhep.2001.22172","article-title":"A model to predict survival in patients with end-stage liver disease","volume":"33","author":"Kamath","year":"2001","journal-title":"Hepatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1200\/JCO.2014.57.9151","article-title":"Assessment of liver function in patients with hepatocellular carcinoma: A new evidence-based approach-the ALBI grade","volume":"33","author":"Johnson","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1002\/hep.510240201","article-title":"An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group","volume":"24","author":"Bedossa","year":"1996","journal-title":"Hepatology"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Choi, A.Y., and Chang, K.J. (2022). Endoscopic Diagnosis of Portal Hypertension. Tech. Innov. Gastrointest. Endosc.","DOI":"10.1016\/j.tige.2022.01.003"},{"key":"ref_29","unstructured":"R Core Team (2021, November 30). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_30","unstructured":"Therneau, T. (2021, November 30). A Package for Survival Analysis in R. R Package Version 3.2-7. Available online: https:\/\/CRAN.R-project.org\/package=survival."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/j.1477-2574.2011.00326.x","article-title":"Refining the definition of perioperative mortality following hepatectomy using death within 90 days as the standard criterion","volume":"13","author":"Mayo","year":"2011","journal-title":"HPB (Oxford)"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e1431","DOI":"10.1097\/MD.0000000000001431","article-title":"The Prognostic Value of Platelet Count in Patients With Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis","volume":"94","author":"Pang","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.3748\/wjg.v10.i17.2472","article-title":"Thrombocytosis: A paraneoplastic syndrome in patients with hepatocellular carcinoma","volume":"10","author":"Hwang","year":"2004","journal-title":"World J. Gastroenterol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jamcollsurg.2011.01.004","article-title":"Importance of low preoperative platelet count in selecting patients for resection of hepatocellular carcinoma: A multi-institutional analysis","volume":"212","author":"Maithel","year":"2011","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1275720","DOI":"10.1155\/2018\/1275720","article-title":"Preoperative Thrombocytopenia May Predict Poor Surgical Outcome after Extended Hepatectomy","volume":"2018","author":"Golriz","year":"2018","journal-title":"Can. J. Gastroenterol. Hepatol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1159\/000489833","article-title":"Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma","volume":"8","author":"Scheiner","year":"2019","journal-title":"Liver Cancer"},{"key":"ref_37","first-page":"21","article-title":"Baveno Vii\u2014Renewing Consensus in Portal Hypertension","volume":"30","author":"Franchis","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1002\/hep.21941","article-title":"Platelet count is not a predictor of the presence or development of gastroesophageal varices in cirrhosis","volume":"47","author":"Qamar","year":"2008","journal-title":"Hepatology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1053\/j.gastro.2012.10.001","article-title":"Elastography, spleen size, and platelet count identify portal hypertension in patients with compensated cirrhosis","volume":"144","author":"Berzigotti","year":"2013","journal-title":"Gastroenterology"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/3\/124\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:29:11Z","timestamp":1760135351000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/3\/124"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":39,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["curroncol29030124"],"URL":"https:\/\/doi.org\/10.3390\/curroncol29030124","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}