Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7895
Peer-review started: January 6, 2015
First decision: February 13, 2015
Revised: March 1, 2015
Accepted: April 3, 2015
Article in press: April 3, 2015
Published online: July 7, 2015
AIM: To investigate the association between thrombocytopenia and relapse after treatment for hepatocellular carcinoma (HCC).
METHODS: We searched the PubMed, EMBASE, and Web of Science databases to obtain eligible studies. The hazard ratios (HRs) values and 95% confidence intervals (CIs) were pooled by random effects model. Subsequently, we estimated the heterogeneity, performed a sensitivity analysis, determined the publication bias, and performed subgroup and meta-regression analyses. Study quality was assessed by using the Oxford Center for Evidence Based Medicine tool.
RESULTS: We identified 18 eligible studies by retrieval (published during 2000-2014). Out of the 4163 patients with HCC who were recruited, 2746 (66.0%) experienced recurrence. In general, our meta-analysis suggested that low platelet count (PLT) before therapy significantly increased the probability of postoperative recurrence (HR = 1.53, 95%CI: 1.29-1.81). PLT was also valuable in the prediction of intrahepatic distant recurrence (HR = 1.49, 95%CI: 1.25-1.77). Subgroup and meta-regression analyses identified various therapeutic modalities as the source of a high degree of heterogeneity. The pooled HR values showed no obvious change when a single study was removed, but otherwise, an opposite-effects model was used. In addition, no significant publication bias was detected.
CONCLUSION: Thrombocytopenia before treatment might be an inexpensive and useful predictor of postoperative recurrence in patients with HCC.
Core tip: The probability of high postoperative recurrence is the greatest problem that affects the potential curative treatment of patients with hepatocellular carcinoma (HCC). No factors have been widely considered as useful predictors for postoperative recurrence in HCC. We analyzed 18 relevant studies to determine the significance of platelet count. We included 4163 patients with HCC and found that thrombocytopenia before therapy significantly increased the probability of postoperative recurrence as well as intrahepatic distant recurrence. We emphasize that thrombocytopenia is an inexpensive, helpful predictor of postoperative recurrence in patients with HCC.