Mean platelet volume and platelet distribution width as predicting biomarkers of hepatitis C related hepatocellular carcinoma

Abstract

Background and Aims: Besides their role in hemostasis and thrombosis; platelets have roles in innate and adaptive immune responses, atherosclerosis, lymphatic vessel development, angiogenesis and carcinogenesis .The relation between platelets and cancer is well-known and thrombocytosis may occur as a paraneoplastic syndrome. Several studies reported a correlation of high platelet count with poor prognosis in different malignancies. The aim of this study was to explore the predictive values of platelet count (PLC), mean platelet volume (MPV) & platelet distribution width (PDW) in HCV related HCC, as well as their association with tumor burden. Method: The study was conducted on two groups of patients, group 1; included patients with naive HCV related HCC and group 2; included patients with chronic HCV cirrhosis. Liver biochemical tests, AFP, serum creatinine, multi-phasic contrast enhanced abdominal CT and or MRI were done at baseline for all cases. In Group 1, non-invasive diagnosis of HCC in cirrhotic patients according to the EASL guidelines & Barcelona Clinic Liver Cancer (BCLC) staging was done. In Group 2, liver cirrhosis was diagnosed through liver histology or a combination of radiographic, clinical, and laboratory findings. CBC was done for all participating patients using automated hematology analyzer with reporting of PLC, MPV& PDW. Results: Group 1 included 144 patients, while group 2 included 116 patients. In group 1, the age was significantly older & the number of males was significantly higher. PLC was significantly lower in group 1 than group 2. In group 1, PLC was < 150× 109/L (thrombocytopenia) in 71.6% of the cases, while it was normal in 28.4% of them. The median HCC diameter was significantly larger in patients with normal PLC than thrombocytopenic patients. There was significant positive correlation of PLC with BCLC stage. PLC was significantly higher in late than early BCLC stage. In group 1; PLC at cut off value of 134.5×109/L predicted late BCLC stages; with sensitivity of 44.1%, specificity of 82.5%, AUC of 0.65 & p = 0.006. There was insignificant difference between both groups regarding PDW. There was insignificant difference between both groups regarding PDW. There was insignificant difference between both groups regarding the MPV. In group 1; PDW was ≥14.5% in 79% & <14.5% in 21% of the patients while MPV was ≥10.4 fl in 52.1% of the patients & <10.4 fl in 47.9% of them. There was insignificant correlation of MPV & PDW with BCLC stage. PDW at cut off value of 15.05% predicted HCV related HCC with sensitivity = 62, 2%, specificity = 58, 1 %, AUC = 57, 8 %, p = 0.043. There was significant negative correlation of the MPV with serum AFP level. MPV was significantly smaller in late than early BCLC stage. On multivariate logistic regression analysis, gender, patient status of performance (PS), Alpha fetoprotein (AFP), PLC, Albumin -Bilirubin (ALBI) grade and Model of End stage Liver Disease (MELD) score, were significant predictors of HCV related HCC, while age, PDW, MPV and Child -Turcotte -Pugh (CTP) score were not significant predictors. Conclusion: PLC was significant predictors of HCV related HCC. HCV related HCC patients with normal PLC had larger tumor diameter. PLC positively correlated with BCLC stage. In HCV related HCC cases, PLC at cut off value of 134.5×109/L may predict late BCLC stages. PDW at cut off 15.05% may predict HCV related HCC. MPV was significantly smaller in late than early BCLC stages & it negatively correlated with serum AFP level. MPV was not significant predictors of HCV related HCC.