Lv Yinzhang, Xu Anhui, Wang Nan, Mu Ketao, Wang Zi, Zhao Lingyun, Huang Yanrong, Peng Ling, Xiang Kun, Hu Daoyu, Qi Jianpin
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J BUON. 2019 Nov-Dec;24(6):2385-2393.
To discuss postoperative thrombocytopenia in the treatment of hepatocellular carcinoma (HCC) through transcatheter arterial chemoembolization (TACE) with single application of Lobaplatin as chemotherapy drug.
The study retrospectively analyzed 1,945 HCC patients treated with TACE in our hospital from May 2013 to May 2018. The number of first-time users of lobaplatin reached 128, the second-time users reached 417, the third-time and above users 239. The analysis examined various items of patients, including gender, age, multiple preoperative examination indicators (platelet level, liver function tests, AFP level), ascites, preoperative presence of peptic ulcer at the initial (3-7 days) and long-term (21-90 days) postoperative stages. Platelet levels were evaluated according to the WHO Grading System for Hematologic Toxicity for side effects of anticancer drugs.
For HCC patients with normal pre-intervention platelet level, the incidences of mild decrease, moderate decrease and severe decrease after intervention were 16.50%, 10.47% and 4.88% respectively, the incidences of long-term platelet reduction after intervention were 13.25%, 4.73% and 1.65% respectively. The level of post-intervention thrombocytopenia was not correlated with the cycles of lobaplatin use. The initial thrombocytopenia was more obvious in female patients after intervention. The presence or absence of peptic ulcer and ascites before the intervention had an effect on the initial thrombocytopenia after the intervention. Platelet level before intervention was correlated with that after intervention. The liver function grading before intervention had no effect on the two levels of thrombocytopenia after intervention. There was a correlation between AFP level grouping before intervention and initial thrombocytopenia after intervention.
The long-term incidence of thrombocytopenia after interventional therapy was not high in TACE patients with HCC treated with LPT alone, which was relatively safe. Besides, the occurrence of thrombocytopenia after intervention had certain characteristics, which can be used to guide clinical practice, so as to reduce the incidence of thrombocytopenia or provide targeted symptomatic support treatment.
探讨以洛铂作为化疗药物单次经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）后的术后血小板减少情况。
本研究回顾性分析了2013年5月至2018年5月在我院接受TACE治疗的1945例HCC患者。首次使用洛铂的患者有128例，第二次使用的有417例，第三次及以上使用的有239例。分析检查了患者的各项指标，包括性别、年龄、多项术前检查指标（血小板水平、肝功能检查、甲胎蛋白水平）、腹水情况、术前是否存在消化性溃疡以及术后初期（3 - 7天）和长期（21 - 90天）的情况。根据世界卫生组织抗癌药物副作用血液学毒性分级系统评估血小板水平。
对于干预前血小板水平正常的HCC患者，干预后轻度减少、中度减少和重度减少的发生率分别为16.50%、10.47%和4.88%，干预后长期血小板减少的发生率分别为13.25%、4.73%和1.65%。干预后血小板减少的程度与洛铂使用周期无关。干预后女性患者初期血小板减少更为明显。干预前是否存在消化性溃疡和腹水对干预后的初期血小板减少有影响。干预前血小板水平与干预后相关。干预前肝功能分级对干预后两个阶段的血小板减少无影响。干预前甲胎蛋白水平分组与干预后初期血小板减少之间存在相关性。
单独使用洛铂治疗的HCC患者经TACE介入治疗后血小板减少的长期发生率不高，相对安全。此外，干预后血小板减少的发生具有一定特点，可用于指导临床实践，从而降低血小板减少的发生率或提供针对性的对症支持治疗。
