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.

Keywords:
Albumin, Hepatocellular carcinoma, Turkey, α-Fetoprotein, Tumor mass, Aggressiveness
1.
Okuda K, Ohtsuki T, Obata H, et al: Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Cancer 1985;56:918-928.
2.
Carr BI, Guerra V: A hepatocellular carcinoma aggressiveness index and its relationship to liver enzyme levels. Oncology 2016;90:215-220.
3.
Carr BI, Guerra V, Giannini EG, Farinati F, et al: A liver index and its relationship to indices of HCC aggressiveness. J Integr Oncol 2016;5.pii:178.
4.
Sirivatanauksorn Y, Tovikkai C: Comparison of staging systems of hepatocellular carcinoma. HPB Surg 2011;2011:818217.
5.
Chen ZH, Hong YF, Lin J, Li X, et al: Validation and ranking of seven staging systems of hepatocellular carcinoma. Oncol Lett 2017;14:705-714.
6.
Kudo M, Matsui O, Izumi N, Iijima H, et al; Liver Cancer Study Group of Japan: Surveillance and diagnostic algorithm for hepatocellular carcinoma proposed by the Liver Cancer Study Group of Japan: 2014 update. Oncology 2014;87(suppl 1):7-21.
7.
Terzi E, Salvatore V, Negrini G, Piscaglia F: Ongoing challenges in the diagnosis of hepatocellular carcinoma. Expert Rev Gastroenterol Hepatol 2016;10:451-463.
8.
Carr BI, Guerra V: HCC and its microenvironment. Hepatogastroenterology 2013;60:1433-1437.
9.
Carr BI, Guerra V, Pancoska P: Thrombocytopenia in relation to tumor size in patients with hepatocellular carcinoma. Oncology 2012;83:339-345.
10.
Yamashita Y, Takahashi M, Baba Y, Kanazawa S: Hepatocellular carcinoma with or without cirrhosis: a comparison of CT and angiographic presentations in the United States and Japan. Abdom Imaging 1993;18:168-175.
11.
Lu SN, Wang JH, Liu SL, Hung CH, et al: Thrombocytopenia as a surrogate for cirrhosis and a marker for the identification of patients at high-risk for hepatocellular carcinoma. Cancer 2006;107:2212-2222.
12.
Huang WJ, Jeng YM, Lai HS, Sheu FY, et al: Tumor size is a major determinant of prognosis of resected stage I hepatocellular carcinoma. Langenbecks Arch Surg 2015;400:725-734.
13.
Silva JP, Gorman RA, Berger NG, Tsai S, et al: The prognostic utility of baseline alpha-fetoprotein for hepatocellular carcinoma patients. J Surg Oncol 2017, DOI: 10.1002/jso.24742.
14.
Cabibbo G, Craxì A: Epidemiology, risk factors and surveillance of hepatocellular carcinoma. Eur Rev Med Pharmacol Sci 2010;14:352-355.
15.
Colombo M, Sangiovanni A: Etiology, natural history and treatment of hepatocellular carcinoma. Antiviral Res 2003;60:145-150.
© 2017 S. Karger AG, Basel
2017
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