Hepatocellular Carcinoma Size: Platelets, γ-Glutamyl Transpeptidase, and Alkaline Phosphatase

Abstract

Background: Thrombocytopenia is a cirrhosis surrogate which is associated with hepatocellular carcinoma (HCC) development. Aims: To compare the clinical characteristics of HCC in the presence and absence of thrombocytopenia. Methods: The baseline clinical data of a large cohort of randomly presenting, biopsy-proven HCC patients was examined for phenotypic patterns, after organizing the data by tumor size and subdivision into tumor size terciles. Results: Small tumor size tercile I patients had the lowest platelet counts. Patients with higher platelets within each size tercile had the lowest bilirubin and prothrombin time and higher γ-glutamyl transpeptidase (GGTP) and alkaline phosphatase (ALKP) levels. When patients with similar platelet and bilirubin levels were compared, α-fetoprotein, GGTP, and ALKP were significantly increased in patients with larger tumors and in the presence of portal vein thrombus. Large tumor size tercile III patients without thrombocytopenia had larger tumors, higher GGTP and ALKP, and lower bilirubin levels than did patients with thrombocytopenia. Conclusions: Thrombocytopenia occurred in 40.7% of patients with smaller tumors but only in 11.3% of patients with larger tumors. Patients without thrombocytopenia had elevated GGTP and ALKP and lower bilirubin levels, regardless of tumor size, but they also had larger tumors within the large tumor tercile.

New nomogram predicts the recurrence of hepatocellular carcinoma in patients with negative preoperative serum AFP subjected to curative resection

“…Similar to the results of our previous study in 2007, macronodular cirrhosis was reported to be an independent factor for the evaluation of recurrence because of its underlying malignant transformation of liver cirrhosis . The results of this study and previous studies indicate that increased GGT is closely associated with the development of HCC because of its positive correlation with tumor size and poor OS . A prognostic nomogram for recurrence prediction in HCC patients was constructed by Ju Hyun Shim in 2015.…”

Hepatocellular Carcinoma Extrahepatic Metastasis in Relation to Tumor Size and Alkaline Phosphatase Levels

“…Similar findings for HCC metastasis have been noted previously [29,30,31]. Lower levels of cirrhosis, absence of thrombocytopenia (low platelets being a reflection of liver fibrosis) and large sizes of HCCs have been documented together [32]. Since large-size HCCs can also occur in cirrhosis, the absence of cirrhosis as a permissive factor in allowing expansion of HCCs without causing patient death from parenchymal destruction can only be a partial explanation of the inverse relationship between HCC size and cirrhosis [33].…”

Quantum biophysics of water

“…In that group, the mean MTD was 3.72 cm in the thrombocytopenia subgroup, compared to 8.78 cm in the normal platelet subgroup. The relationship between blood platelet levels and MTD is also depicted in FIGURE 2, in which an increase in tumor size was found to be associated with a significant increase in mean platelet values, as reported in other analyses [27,28]. …”

“…GGTP has been found to be a useful tumor marker by others, especially in low AFP HCCs [21,29,30–33] and so, to a lesser extent has ALKP [34]. Platelets were found to be associated with an increase in MTD, especially for the larger size tumors, but there was an association between MTD and platelet numbers (TABLE 4 and FIGURE 2), as noted elsewhere [27,28] and there was a greater percent of PVT in the larger tumors (TABLES 2, 4 and FIGURE 1). The reason for this is unclear.…”