Characteristics of Hepatocellular Carcinoma Aggressiveness Factors in Turkish Patients

Abstract

A large cohort of hepatocellular carcinoma (HCC) patients from several collaborating Turkish institutions were examined for the tumor parameters of maximum diameter (MTD), portal vein thrombosis (PVT), and α-fetoprotein (AFP) levels. A relationship was found between MTD and blood platelet levels. Patients with large ≥5 cm tumors who had normal platelet levels had significantly larger tumors, higher percent of PVT, and significantly lower blood total bilirubin and liver cirrhosis than similar ≥5 cm tumor patients having thrombocytopenia. A comparison of patients with and without PVT showed significantly larger tumors, greater multifocality, blood AFP, and C-reactive protein levels, and, interestingly, lower HDL levels in the patients with PVT. Fifty-eight percent of the total cohort had AFP levels ≤100 IU/mL (and 42.1% had values ≤20 IU/mL). These patients had significantly smaller tumors, less tumor multifocality and percent PVT, lower total bilirubin, and less cirrhosis. There was considerable geographic heterogeneity within Turkey in the patterns of HCC presentation, with areas of higher and lower hepatitis B virus, hepatitis D virus, cirrhosis, and tumor aggressiveness parameters. Turkish patients thus have distinct patterns of presentation, but the biological relationships between MTD and both platelets and bilirubin levels are similar to the relationships that have been reported in other ethnic patient groups.

Inflammatory markers C-reactive protein and PLR in relation to HCC characteristics

“…In this context, we addressed in this work the possible mechanisms that might underlie the prognostic usefulness of CRP, PLR and NLR. A working hypothesis that we have tested here, is that each or any of CRP, PLR or NLR might be related to indices of tumour aggressiveness, namely MTD, AFP, PVT and multifocality, as an explanation of their prognostic ability [30,36,37]. We found CRP was significantly related to MTD, AFP and PVT, and the Glasgow Index to MTD and AFP.…”

“…Diagnosis was made either through tumour biopsy or according to international guidelines. Database management conformed to legislation on privacy and this study conforms to the ethical guidelines of the Declaration of Helsinki and approval for this retrospective study on de-identified HCC patients was obtained by the Institutional Review Board of each participating institution [30].…”

Safety and efficacy analysis of microwave ablation in small hepatocellular carcinomas sized below 3 cm

“…This is because the male/female ratio of viral hepatitis is higher in Turkey compared to other countries [13]. Because HBV infection is endemic in Turkey, the incidence of HBV was higher in our sample with HCCs compared to the literature; the causative agent was detected as HBV in 24 patients (77.4%) and HCV in seven (22.6%) [14].…”

Platelets and Hepatocellular Cancer: Bridging the Bench to the Clinics

“…However, there is also evidence stemming from clinical studies showing that the presence of thrombocytosis rather than thrombocytopenia may be associated with worse prognosis in patients with HCC, and that, in these patients, the presence of increased platelet count can be considered a marker of enhanced tumor aggressiveness and poorer survival [87,88,89,90]. More in detail, thrombocytosis is associated with greater tumor burden and more biological aggressiveness in patients with HCC [87,88,89,90]. Moreover, other studies have shown that an elevated pretreatment platelet count is associated with a higher risk of extra-hepatic spread in patients with early and very early HCC (HR = 2.12, 95%CI = 1.67–2.70), showing a diagnostic ability even superior in respect to AFP [72,73].…”