Elevated Platelet Count is Associated with Poor Survival After Transarterial Chemoembolization Treatment in Patients with Hepatocellular Carcinoma: A Cohort Study

BACKGROUND: Platelet count (PLT) has been proved as an essential biomarker for the survival of hepatocellular carcinoma (HCC). However, the prognostic value of PLT change (ΔPLT) is still uncertain. The aim of this study was to explore the relationship between ΔPLT and HCC survival after transarterial chemoembolization (TACE) treatment. METHODS: Cox proportional hazard regression models were used to calculate multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for HCC. The non-linear relationship between ΔPLT and OS was estimated through a restricted cubic spline regression analysis, and a two-piece-wise Cox proportional hazard model was further performed to calculate the threshold effect. RESULTS: A total of 597 HCC patients treated with TACE were selected for the secondary analysis. Compared with the ΔPLT within ±20 (×10(9)/L), ΔPLT≥20 (×10(9)/L) was significantly associated with an 64% increase in risk of death (HR, 1.64; 95% CI: 1.21 to 2.22) after adjustment for confounding variables, but the association was not significant in the group of ΔPLT≤-20 (HR, 1.23; 95% CI: 0.92 to 1.63). We also found a U-shape relationship between ΔPLT and HCC survival at the turning point of ΔPLT as 0 (20×10(9)/L). The HR for the death was 1.12 (95% CI: 1.06, 1.18) with ΔPLT≥0 (20×10(9)/L) while 0.95 (95% CI: 0.92, 0.98) with ΔPLT<0 (20×10(9)/L). After potential confounding factors were adjusted, the non-linear relationship between ΔPLT and OS was still significant (P=0.013). Besides, ΔPLT≥20 (×10(9)/L) was associated with new lesions (OR, 2.74; 95% CI: 1.38 to 5.45). CONCLUSION: Elevated PLT was associated with poor overall survival of HCC patients after TACE treatment.