title: Significance of platelet count and platelet-based models for hepatocellular carcinoma recurrence.
abstract: OBJECTIVE
  To explore the effects of platelet count (PLT) and 11 platelet-based indices on postoperative recurrence of hepatocellular carcinoma (HCC).
  
  
  METHODS
  We retrospectively analyzed 172 HCC patients who were treated by partial hepatectomy. Preoperative data, including laboratory biochemical results, were used to calculate the 11 indices included in the analysis. We performed receiver operating characteristic curve analysis to determine the optimal cut-off values for predicting recurrence. Cumulative rates of HCC recurrence were calculated using Kaplan-Meier survival curves and differences were analyzed by log-rank tests. Multivariate analyses were performed to identify independent predictors of recurrence, early recurrence (within one year after surgery), and late recurrence in HCC. To obtain better prognostic models, PLT-based indices were analyzed separately after being expressed as binary and continuous variables. Two platelet-unrelated, validated HCC prognostic models were included in the analyses as reference indices. Additional analyses were performed after patients were stratified based on hepatitis B virus infection status, cirrhosis, and tumor size to investigate the significance of platelets in different subgroups.
  
  
  RESULTS
  In the study cohort, 44.2% (76/172) of patients experienced HCC recurrence, and 50.6% (87/172) died during a median follow-up time of 46 mo. PLT and five of the 11 platelet-related models were significant predisposing factors for recurrence (P < 0.05). Multivariate analysis indicated that, among the clinical parameters, presence of ascites, PLT ≥ 148 × 10(9)/L, alkaline phosphatase ≥ 116 U/L, and tumor size ≥ 5 cm were independently associated with a higher risk of HCC recurrence (P < 0.05). Independent and significant models included the aspartate aminotransferase/PLT index, fibrosis index based on the four factors, fibro-quotient, aspartate aminotransferase/PLT/γ-glutamyl transpeptidase/alpha-fetoprotein index, and the PLT/age/alkaline phosphatase/alpha-fetoprotein/aspartate aminotransferase index. There were different risk factors between early and late recurrences, and PLT and these indices were more inclined to influence late recurrence. PLT was only predictive of recurrence in non-cirrhotic HCC patients, and was not influenced by tumor size, which was a critical confounder in our study.
  
  
  CONCLUSIONS
  PLT and PLT-based noninvasive models are effective tools for predicting postoperative recurrence, especially late recurrence. Larger cohorts are needed to validate our findings.
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Pang
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Jing-Yao
authors.initials: JY
authors.lastname: Zhang
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Xin-Sen
authors.initials: XS
authors.lastname: Xu
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Si-Dong
authors.initials: SD
authors.lastname: Song
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Qu
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Yan-Yan
authors.initials: YY
authors.lastname: Zhou
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Run-Chen
authors.initials: RC
authors.lastname: Miao
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Su-Shun
authors.initials: SS
authors.lastname: Liu
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Ya-Feng
authors.initials: YF
authors.lastname: Dong
authors.affiliation: Qing Pang, Jing-Yao Zhang, Xin-Sen Xu, Si-Dong Song, Kai Qu, Wei Chen, Yan-Yan Zhou, Run-Chen Miao, Su-Shun Liu, Chang Liu, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China.
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001201:Ascites / Q000097:blood / Q000473:pathology; D014408:Biomarkers, Tumor / Q000097:blood; D001792:Blood Platelets; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003661:Decision Support Techniques; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D010976:Platelet Count; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor
keywords: Alkaline phosphatase; Alpha-fetoprotein; Aspartate aminotransferase; Blood platelets; Hepatocellular carcinoma; Recurrence