Department of Thoracic Oncology, Senior Department of Respiratory and Critical CareMedicine, the Eighth Medical Center of PLA General Hospital, A17, Heishanhu Road, Haidian District, Beijing, 100091, China.
Senior Department of Oncology, the Fifth Medical Center of Chinese PLA General Hospital, No. 8 Dongda Street, Fengtai District, Beijing, 100071, China.
Sci Rep. 2024 Nov 16;14(1):28350. doi: 10.1038/s41598-024-79416-w.
Generally, invasive treatment is contraindication for patients with severe thrombocytopenia, because it may increase risk of bleeding. However, many early hepatocellular carcinoma (HCC) patients with cirrhosis have platelet counts (PC) less than 50 × 10/L due to hypersplenism. These patients are often accompanied by hepatic insufficiency, which makes hepatectomy impossible, and local thermal ablation (LTA) has become a major treatment. The aim of our study is to investigate the correlation between severe thrombocytopenia and bleeding after LTA in HCC patients with cirrhosis, and evaluate risk factors of bleeding. 473 patients with cirrhosis who underwent LTA for HCC from 2016 to 2020 were enrolled, and 709 ablations were performed in total. Based on preoperative PC, cases were divided into three groups, namely, group A (PC > 50 × 10/L), group B (30 × 10/L < PC ≤ 50 × 10/L) and group C (PC ≤ 30 × 10/L). The incidence of bleeding after LTA was compared among the three groups. Logistic regression was used to explore the risk factors for bleeding after ablation. The overall incidence of bleeding complications was 4.4%, and no significant difference was observed between group A, B, and C (3.9% vs. 6.4% vs. 3.3%, P = 0.410). In multivariate analysis, tumor diameter (OR = 2.657 per 1 cm, P < 0.001), and multiple lesions (≥ 3) (OR = 3.723, P = 0.006) were found to be independent predictors of bleeding after LTA. In small HCC patients with cirrhosis and hypersplenism, the PC range 30-50 × 10/L will not increase the risk of bleeding after LTA. Tumor diameter and number of lesions are independent predictors for bleeding after LTA in HCC patients.
一般来说，严重血小板减少症患者是侵入性治疗的禁忌，因为这可能会增加出血的风险。然而，许多早期肝硬化合并肝细胞癌（HCC）患者的血小板计数（PC）由于脾功能亢进而低于 50×10/L。这些患者常伴有肝功能不全，使肝切除术无法进行，局部热消融（LTA）成为主要治疗方法。我们的研究目的是探讨肝硬化合并 HCC 患者严重血小板减少症与 LTA 后出血的相关性，并评估出血的危险因素。2016 年至 2020 年间，共纳入 473 例因 HCC 接受 LTA 的肝硬化患者，共进行了 709 次消融。根据术前 PC，将病例分为三组，即 A 组（PC＞50×10/L）、B 组（30×10/L＜PC≤50×10/L）和 C 组（PC≤30×10/L）。比较三组患者 LTA 后出血的发生率。采用 logistic 回归分析探讨消融后出血的危险因素。总的出血并发症发生率为 4.4%，A、B 和 C 组之间无显著差异（3.9%比 6.4%比 3.3%，P=0.410）。多因素分析发现，肿瘤直径（每增加 1cm，OR=2.657，P＜0.001）和多发病灶（≥3 个）（OR=3.723，P=0.006）是 LTA 后出血的独立预测因素。在伴有脾功能亢进的小 HCC 肝硬化患者中，PC 范围在 30-50×10/L 不会增加 LTA 后出血的风险。肿瘤直径和病灶数量是 HCC 患者 LTA 后出血的独立预测因素。
