# Impact of Thrombocytopenia on Survival in Patients with Hepatocellular Carcinoma: Updated Meta-Analysis and Systematic Review

## TL;DR

This study finds that low platelet levels in liver cancer patients are linked to worse survival outcomes, suggesting platelets could help predict prognosis.

## Contribution

The study provides updated meta-analysis evidence that thrombocytopenia is a prognostic marker for hepatocellular carcinoma.

## Key findings

- Thrombocytopenia in HCC patients is associated with poor overall survival (HR = 1.15–1.30).
- Platelet indices correlate with tumor characteristics like size and number of foci.

## Abstract

Currently, hepatocellular carcinoma (HCC) is one of the most prevalent oncological diagnoses worldwide. Despite intensive research into its pathogenesis and clinical course, numerous issues remain unresolved. In the presented meta-analysis and systematic review, we investigate the potential of blood platelet levels in patients with HCC for prognostic assessment. Blood platelets may play a significant role as an easily measurable laboratory parameter in assessing the prognosis of patients with HCC.

Background: Platelets (PLT) have a role in the pathogenesis, progression, and prognosis of hepatocellular carcinoma (HCC) and could represent a readily measurable laboratory parameter to enhance the comprehensive evaluation of HCC patients. Methods: The PubMed, Web of Science, and Scopus databases were searched with a focus on survival as well as patient and tumor-specific characteristics in correlation to reported PLT counts. Survival outcomes were analyzed with both common-effect and random-effects models. The hazard ratio (HR) and its 95% confidence interval (CI) from analyzed trials were incorporated. Studies that did not provide survival data but focused on platelet count correlation with HCC characteristics were reviewed. Results: In total, 26 studies, including a total of 9403 patients, met our criteria. The results showed that thrombocytopenia in HCC patients was associated with poor overall survival (common-effect HR = 1.15, 95% CI: 1.06–1.25; random-effect HR = 1.30, 95% CI: 1.05–1.63). Moreover, three studies reveal significant correlations between PLT indices and tumor characteristics such as size, foci number, and etiology of HCC development. Conclusion: Our meta-analysis confirmed that PLT count could act as a prognostic marker in HCC, especially with a PLT count cut off <100 × 103/mm3. Further prospective studies focusing on the role of PLT in clearly defined subgroups are necessary.