Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 7, 2015; 21(25): 7895-7906
Published online Jul 7, 2015. doi: 10.3748/wjg.v21.i25.7895
Thrombocytopenia for prediction of hepatocellular carcinoma recurrence: Systematic review and meta-analysis
Qing Pang, Kai Qu, Jian-Bin Bi, Su-Shun Liu, Jing-Yao Zhang, Si-Dong Song, Ting Lin, Xin-Sen Xu, Yong Wan, Ming-Hui Tai, Hao-Chen Liu, Ya-Feng Dong, Chang Liu
Qing Pang, Kai Qu, Jian-Bin Bi, Su-Shun Liu, Jing-Yao Zhang, Si-Dong Song, Ting Lin, Xin-Sen Xu, Yong Wan, Ming-Hui Tai, Hao-Chen Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Ya-Feng Dong, Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, KS 66045, United States
Author contributions: Pang Q and Qu K contributed equally to this work; Pang Q, Dong YF and Liu C designed the study; Pang Q and Zhang JY performed the literature search; Pang Q, Qu K, Song SD extracted the data; Lin T, Xu XS and Tai MH contributed to quality evaluation for each study and drew the forest plots; Pang Q, Qu K and Zhang JY wrote the paper; and Bi JB, Liu SS, Lin T, Xu XS, Wan Y and Liu HC revised the paper.
Supported by National Natural Science Foundation of China, No. 81272644 and No. 81072051.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email: liuchangdoctor@163.com. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Liu, Professor, MD, PhD, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi’an Jiaotong University, No. 277 West Road, Yanta district, Xi’an 710061, Shaanxi Province, China. liuchangdoctor@163.com
Telephone: +86-29-82653900 Fax: +86-29-82653905
Received: January 5, 2015
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
Abstract

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.

Keywords: Hepatocellular carcinoma, Blood platelets, Thrombocytopenia, Recurrence, Prognosis

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.