An Association Between Platelet Count and Hepatocellular Carcinoma Overall Survival: A Secondary Analysis

Background: Recent evidence shows that platelets act as critical factors in hepatocellular carcinoma (HCC) proliferation1 and contribute to the distant metastasis. Platelet count(PLT) has been proved as an essential biomarker for HCC development. However, the nonlinear relationship between PLT and HCC overall survival is still unclear. Methods: Cox proportional hazards regression models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% CIs for HCC. The nonlinear relationship was estimated through a restricted cubic spline regression, and a two-piece-wise Cox proportional hazards model was further performed to calculate the threshold effect. We used multiple imputation to deal with the missing data. Findings: A total of 971 newly diagnosed HCC patients with Barcelona clinic liver cancer stage B were identified for the secondary analysis. In the multivariate analysis, Log PLT was associated with an 88% risk increase of death(HR, 1.88;1.27 to 2.80) with adjustment for gender, Child-Pugh class, age X diameter of main tumour, both lobe with lesions X No. of the intrahepatic lesions, AFP( 10.83 after adjusting for potential confounders. The core results were consistent with those from the sensitivity analysis. Besides, a significantly higher hazard risk was found in the patients with age 50 mm, Hgb≥120 g/L and CRP>10 mg/L. Conclusion: Platelet count was nonlinearly associated with hepatocellular carcinoma overall survival. Funding Statement: This research received financial support from the National Natural Science Foundation of China (Nos 81502360); the Natural Science Foundation of Fujian Province (Nos 2018J01352 and 2016J01576 and 2016J01586); the Science and Technology Innovation Joint Foundation of Fujian Province(Nos 2017Y9125). Declaration of Interests: The authors state: "None." Ethics Approval Statement: The Department approved this study protocol (2017-FXY-129) of Clinical Research of Sun Yat-sen University Cancer Center. Because this was a secondary analysis study, and the data were anonymous, the requirement for informed consent was waived.