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Purpose <p>To evaluate the prognostic significance of platelet count abnormalities, specifically thrombocytosis and thrombocytopenia, across diverse liver disease etiologies and fibrosis stages in patients undergoing curative resection for hepatocellular carcinoma (HCC).</p> Methods <p>We retrospectively analyzed 1,215 patients who underwent initial curative HCC resection. The patients were stratified by platelet count (thrombocytopenia &lt; 100 × 10⁹/L; thrombocytosis ≥ 200 or ≥ 300 × 10⁹/L). We assessed the prognostic impact on the overall survival (OS) and recurrence-free survival (RFS) across etiologies (HBV, HCV, non-B/non-C), fibrosis stages, and specific subgroups (MASLD, SVR-HCV), alongside an aspirin use analysis.</p> Results <p>Both thrombocytopenia and thrombocytosis independently predicted a poor OS, whereas only thrombocytosis was a significant independent predictor of a poor RFS. Thrombocytosis adversely affected the OS across all etiologies except HBV, whereas it predicted a poor RFS specifically in patients with HBV infection. Notably, patients with MASLD and thrombocytosis exhibited the highest risk of a poor OS (HR: 3.54). Aspirin use significantly improved the RFS in the non-B/non-C, MASLD, and non-cirrhotic cohorts, but it provided no survival benefit in patients with thrombocytosis.</p> Conclusion <p>Thrombocytopenia and thrombocytosis are independent predictors of a poor prognosis after HCC resection, with distinct etiology-specific impacts. MASLD-related HCC is particularly vulnerable to platelet-mediated tumor promotion. While aspirin may benefit selected subgroups, it has shown limited efficacy in patients with thrombocytosis.</p>

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Platelet count as a prognostic biomarker in resected hepatocellular carcinoma: differential impact of thrombocytosis and thrombocytopenia by btiology and fibrosis

  • 期刊论文

  • 发表日期：

    2026年4月21日

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  • Takashi Matsumoto,
  • Toshiro Masuda,
  • Toru Beppu,
  • Kensuke Yamamura,
  • Yuki Adachi,
  • Tatsunori Miyata,
  • Hirohisa Okabe,
  • Katsunori Imai,
  • Hiromitsu Hayashi,
  • Masaaki Iwatsuki

摘要

Purpose

To evaluate the prognostic significance of platelet count abnormalities, specifically thrombocytosis and thrombocytopenia, across diverse liver disease etiologies and fibrosis stages in patients undergoing curative resection for hepatocellular carcinoma (HCC).

Methods

We retrospectively analyzed 1,215 patients who underwent initial curative HCC resection. The patients were stratified by platelet count (thrombocytopenia < 100 × 10⁹/L; thrombocytosis ≥ 200 or ≥ 300 × 10⁹/L). We assessed the prognostic impact on the overall survival (OS) and recurrence-free survival (RFS) across etiologies (HBV, HCV, non-B/non-C), fibrosis stages, and specific subgroups (MASLD, SVR-HCV), alongside an aspirin use analysis.

Results

Both thrombocytopenia and thrombocytosis independently predicted a poor OS, whereas only thrombocytosis was a significant independent predictor of a poor RFS. Thrombocytosis adversely affected the OS across all etiologies except HBV, whereas it predicted a poor RFS specifically in patients with HBV infection. Notably, patients with MASLD and thrombocytosis exhibited the highest risk of a poor OS (HR: 3.54). Aspirin use significantly improved the RFS in the non-B/non-C, MASLD, and non-cirrhotic cohorts, but it provided no survival benefit in patients with thrombocytosis.

Conclusion

Thrombocytopenia and thrombocytosis are independent predictors of a poor prognosis after HCC resection, with distinct etiology-specific impacts. MASLD-related HCC is particularly vulnerable to platelet-mediated tumor promotion. While aspirin may benefit selected subgroups, it has shown limited efficacy in patients with thrombocytosis.