Importance of Low Preoperative Platelet Count in Selecting Patients for Resection of Hepatocellular Carcinoma: A Multi-Institutional Analysis

作     者：Maithel, Shishir K. Kneuertz, Peter J. Kooby, David A. Scoggins, Charles R. Weber, Sharon M. Martin, Robert C. G., II McMasters, Kelly M. Cho, Clifford S. Winslow, Emily R. Wood, William C. Staley, Charles A., III 

作者机构：Emory Univ Winship Canc Inst Dept Surg Div Surg OncolSch Med Atlanta GA 30322 USA Univ Louisville Sch Med Dept Surg Div Surg Oncol Louisville KY 40292 USA Univ Wisconsin Dept Surg Div Surg Oncol Sch Med & Publ Hlth Madison WI USA 

出 版 物：《JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS》 (美国外科医生学会志)

年 卷 期：2011年第212卷第4期

页      面：638-648页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：NCRR NIH HHS [UL1 RR025011  UL1 RR025011-04  UL1 RR025011-03  UL1 RR025011-05] Funding Source: Medline 

主　　题：Hepatocellular Cancer Death Platelet Count ectomy Mortality Portal Hypertension Hepatectomy Tumor Burden Tumours Human-centered computing Complication Patients 

摘      要：BACKGROUND: Low platelet count is a marker of portal hypertension but is not routinely included in the standard preoperative evaluation of patients with hepatocellular carcinoma (HCC) because it pertains to liver function (Child/model for end-stage liver disease [MELD] score) and tumor burden (Milan criteria). We hypothesized that low platelet count would be independently associated with increased perioperative morbidity and mortality after resection. STUDY DESIGN: Patients treated with liver resection for HCC between January 2000 and January 2010 at 3 institutions were eligible. Preoperative platelet count, Child/MELD score, and tumor extent were recorded. Low preoperative platelet count (LPPC) was defined as 7 mg/dL or development of ascites. Univariate and multivariate regression was performed for predictors of major complications, PLI, and 60-day mortality. RESULTS: A total of 231 patients underwent resection, of whom 196 (85%) were classified as Child A and 35 (15%) as Child B;median MELD score was 8. Overall, 168 (71%) had tumors that exceeded Milan criteria and 134 (58%) had major hepatectomy (= 3 Couinaud segments). Overall and major complication rates were 55% and 17%, respectively. PLI occurred in 25 patients (11%), and 21 (9%) died within 60 days of surgery. Patients with LPPC (n = 50) had a significantly increased number of major complications (28% versus 14%, p = 0.031), PLI (30% versus 6%, p = 0.001), and 60-day mortality (22% versus 6%, p = 0.001). When adjusted for Child/MELD score and tumor burden, LPPC remained independently associated with increased number of major complications (odds ratio [OR] 2.8, 95% confidence intervals [CI] 1.1 to 6.8, p = 0.026), PLI (OR 4.0, 95% CI 1.4 to 11.1, p = 0.008), and 60-day mortality (OR 4.6, 95% CI 1.5 to 14.6, p = 0.009). CONCLUSIONS: LPPC is independently associated with increased major complications, PLI, and mortalit