Lower platelet count and clinical outcomes in patients with BCLC stage B hepatocellular carcinoma

Thrombocytosis is correlated with poor prognosis in several cancers. Barcelona Clinic liver cancer (BCLC) staging, a major index of prognosis prediction and treatment selection for patients with hepatocellular carcinoma (HCC), has not considered platelet count in its protocol yet. This study evaluated the prognostic impact of platelet count in patients with HCC. Briefly, this retrospective cohort study enrolled 925 patients with BCLC stage B HCC. Baseline characteristics were adjusted using propensity score matching. Log-rank tests were performed to determine whether a threshold platelet count of 150 × 10 9 /L stratified patient prognosis. The primary endpoint was overall death. As a result, patients with platelet counts < 150 × 10 9 /L showed significantly better overall survival compared to patients with platelet counts ≥ 150 × 10 9 /L (hazard ratio = 0.7233). Among 553 patients with ≥ 4 HCC nodules, a platelet count cutoff of 150 × 10 9 /L also differentiated patient prognosis (hazard ratio = 0.6059). After adjusting for the baseline characteristics of patients with ≥ 4 HCC by propensity score matching for age, sex, albumin, total bilirubin, primary or recurrence, and maximum tumor diameter, in the matched-pair cohorts, a platelet count < 150 × 10 9 /L significantly correlated with a better overall survival compared to platelet count ≥ 150 × 10 9 /L (hazard ratio = 0.7096). In conclusions, a lower platelet count correlated with better prognosis in patients with multiple HCC nodules.