Department of Anesthesiology and Pain Medicine.
Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Liver Transpl. 2018 Jan;24(1):44-55. doi: 10.1002/lt.24961. Epub 2017 Dec 8.
Platelets interact with tumor cells and promote metastasis. The importance of platelets in posttransplant hepatocellular carcinoma (HCC) recurrence is unclear. Thus, we aimed to evaluate the association between preoperative platelet count (PLT) and HCC recurrence after living donor liver transplantation. Of 359 recipients of livers from living donors for HCC, 209 of 240 patients who had preoperative PLT ≤75 × 10 /L were matched with 97 of 119 patients who had preoperative PLT >75 × 10 /L using propensity score matching, with an unfixed matching ratio based on factors such as tumor biology. The cutoff value of 75 × 10 /L was set based on optimum stratification analysis. Survival analysis was performed with death as a competing risk event. The primary outcome was overall HCC recurrence. The median follow-up time was 59 months. Before matching, recurrence probability at 1, 2, and 5 years after transplantation was 4.7%, 9.2%, and 11.3% for the low platelet group and 14.5%, 23.0%, and 30.5% for the high platelet group. Recurrence risk was significantly greater in the high platelet group in both univariate (hazard ratio [HR] = 3.09; 95% confidence interval [CI], 1.86-5.14; P < 0.001) and multivariate analyses (HR = 2.10; 95% CI, 1.23-3.60; P = 0.007). In the matched analysis, recurrence risk was also greater in the high platelet group in both univariate (HR = 2.33; 95% CI, 1.36-4.01; P = 0.002) and multivariate analyses (HR = 1.90; 95% CI, 1.02-3.54; P = 0.04). Preoperative PLT had no interaction with the Milan criteria, alpha-fetoprotein level, Edmonson grade, microvascular invasion, or intrahepatic metastasis. Incorporation of preoperative PLT into the Milan criteria significantly improved predictive power. Inflammation-based scores including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the inflammation-based index did not show superiority to preoperative PLT in predicting HCC recurrence. In conclusion, preoperative PLT appears to be an important host factor affecting HCC recurrence after living donor liver transplantation. Liver Transplantation 24 44-55 2018 AASLD.
血小板与肿瘤细胞相互作用并促进转移。血小板在肝移植后肝细胞癌（HCC）复发中的重要性尚不清楚。因此，我们旨在评估术前血小板计数（PLT）与活体供肝移植后 HCC 复发之间的关系。在 359 例接受活体供肝移植的 HCC 受体中，根据肿瘤生物学等因素，采用固定比例进行倾向性评分匹配，对 240 例术前 PLT≤75×10/L 的 209 例患者与 119 例术前 PLT>75×10/L 的 97 例患者进行匹配，无固定匹配比例。75×10/L 的截断值基于最佳分层分析确定。以死亡为竞争风险事件进行生存分析。主要结局是 HCC 总复发。中位随访时间为 59 个月。在匹配之前，低血小板组在移植后 1、2 和 5 年的复发概率分别为 4.7%、9.2%和 11.3%，高血小板组分别为 14.5%、23.0%和 30.5%。在单因素（风险比[HR] = 3.09；95%置信区间[CI]，1.86-5.14；P<0.001）和多因素分析（HR = 2.10；95%CI，1.23-3.60；P=0.007）中，高血小板组的复发风险均显著更高。在匹配分析中，高血小板组在单因素（HR = 2.33；95%CI，1.36-4.01；P=0.002）和多因素分析（HR = 1.90；95%CI，1.02-3.54；P=0.04）中也具有更高的复发风险。术前 PLT 与米兰标准、甲胎蛋白水平、Edmonson 分级、微血管侵犯或肝内转移无相互作用。将术前 PLT 纳入米兰标准可显著提高预测能力。包括中性粒细胞与淋巴细胞比值、血小板与淋巴细胞比值和炎症指数在内的炎症评分在预测 HCC 复发方面并不优于术前 PLT。总之，术前 PLT 似乎是影响活体供肝移植后 HCC 复发的重要宿主因素。肝脏移植 24 44-55 2018 AASLD。
