Preoperative platelet count as an independent predictor of long-term outcomes among patients undergoing resection for intrahepatic cholangiocarcinoma

Odysseas P Chatzipanagiotou; Diamantis I Tsilimigras; Giovanni Catalano; Andrea Ruzzenente; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Feng Shen; François Cauchy; Bas Groot Koerkamp; Itaru Endo; Minoru Kitago; Timothy M Pawlik

doi:10.1002/jso.27806

Preoperative platelet count as an independent predictor of long-term outcomes among patients undergoing resection for intrahepatic cholangiocarcinoma

J Surg Oncol. 2024 Aug 13. doi: 10.1002/jso.27806. Online ahead of print.

Authors

Odysseas P Chatzipanagiotou¹, Diamantis I Tsilimigras¹, Giovanni Catalano^{1

2}, Andrea Ruzzenente², Luca Aldrighetti³, Matthew Weiss⁴, Todd W Bauer⁵, Sorin Alexandrescu⁶, George A Poultsides⁷, Shishir K Maithel⁸, Hugo P Marques⁹, Guillaume Martel¹⁰, Carlo Pulitano¹¹, Feng Shen¹², François Cauchy¹³, Bas Groot Koerkamp¹⁴, Itaru Endo¹⁵, Minoru Kitago¹⁶, Timothy M Pawlik¹

Affiliations

¹ Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
² Department of Surgery, University of Verona, Verona, Italy.
³ Department of Surgery, Ospedale San Raffaele, Milan, Italy.
⁴ Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA.
⁵ Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
⁶ Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
⁷ Department of Surgery, Stanford University, Stanford, California, USA.
⁸ Department of Surgery, Emory University, Atlanta, Georgia, USA.
⁹ Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
¹⁰ Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada.
¹¹ Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
¹² Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China.
¹³ Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France.
¹⁴ Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
¹⁵ Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
¹⁶ Department of Surgery, Keio University, Tokyo, Japan.

PMID: 39138891
DOI: 10.1002/jso.27806

Abstract

Background and objectives: An elevated platelet count may reflect neoplastic and inflammatory states, with cytokine-driven overproduction of platelets. The objective of this study was to evaluate the prognostic utility of high platelet count among patients undergoing curative-intent liver surgery for intrahepatic cholangiocarcinoma (ICC).

Methods: An international, multi-institutional cohort was used to identify patients undergoing curative-intent liver resection for ICC (2000-2020). A high platelet count was defined as platelets >300 *10⁹/L. The relationship between preoperative platelet count, cancer-specific survival (CSS), and overall survival (OS) was examined.

Results: Among 825 patients undergoing curative-intent resection for ICC, 139 had a high platelet count, which correlated with multifocal disease, lymph nodes metastasis, poor to undifferentiated grade, and microvascular invasion. Patients with high platelet counts had worse 5-year (35.8% vs. 46.7%, p = 0.009) CSS and OS (24.8% vs. 39.8%, p < 0.001), relative to patients with a low platelet count. After controlling for relevant clinicopathologic factors, high platelet count remained an adverse independent predictor of CSS (HR = 1.46, 95% CI 1.02-2.09) and OS (HR = 1.59, 95% CI 1.14-2.22).

Conclusions: High platelet count was associated with worse tumor characteristics and poor long-term CSS and OS. Platelet count represents a readily-available laboratory value that may preoperatively improve risk-stratification of patients undergoing curative-intent liver resection for ICC.

Keywords: cancer‐specific survival; intrahepatic cholangiocarcinoma; overall survival; platelet count; prognosis; thrombocytosis.