title: Thrombocytopenia in relation to tumor size in patients with hepatocellular carcinoma.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) size at diagnosis is important in management. Without screening programs, tumor size at diagnosis is heterogeneous.
  
  
  OBJECTIVE
  To examine the clinical parameters related to tumor size.
  
  
  METHODS
  Using prospectively collected data from a 1,100-patient biopsy-proven HCC cohort presenting in the absence of screening, tumor sizes were ordered and trichotomized and the resulting terciles were compared for tumor and blood parameters.
  
  
  RESULTS
  The terciles were significantly different with respect to portal hypertension and thrombocytopenia, which were present in a higher percent of tercile I patients with smaller tumors. Tercile III patients with larger HCCs had the highest serum α-fetoprotein (AFP), γ-glutamyl transpeptidase (GGTP), and alkaline phosphatase (ALKP) levels and the most portal vein (PV) thrombosis. Subclassification of tercile I patients by AFP showed that patients with high serum AFP had increased numbers of tumor nodules, more PV thrombosis, higher bilirubin, ALKP, and GGTP levels, and shorter survival.
  
  
  CONCLUSIONS
  Smaller-tumor tercile I patients had more advanced portal hypertension with thrombocytopenia than did larger-tumor patients. Tercile I patients with higher AFP levels had more frequent PV thrombosis and worse survival than those with lower AFP levels. Elevated serum GGTP and ALKP levels appear to be associated with a more aggressive HCC phenotype. These differing patterns suggest more than one HCC pathway.
authors.affiliation: Department of Nutritional Carcinogenesis, IRCCS S. de Bellis National Institute for Digestive Diseases, Castellana Grotte, Italy. brianicarr @ hotmail.com
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
authors.forename: Vito
authors.initials: V
authors.lastname: Guerra
authors.forename: Petr
authors.initials: P
authors.lastname: Pancoska
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D008113:Liver Neoplasms / Q000097:blood* / Q000737:chemistry / Q000175:diagnosis / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000737:chemistry / Q000473:pathology; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000473:pathology*; D020246:Venous Thrombosis / Q000473:pathology; D000509:alpha-Fetoproteins / Q000737:chemistry; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000509:alpha-Fetoproteins; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin