Small hepatocellular carcinomas and thrombocytopenia

Background: Clinical phenotypes of small and large hepatocellular carcinomas (HCCs) are not well characterized. Aim: To evaluate the characteristics of small HCCs diagnosed by screening. Method: A cohort of 430 small HCCs that were diagnosed through screening, were dichotomized according to a size of ≤3 cm or >3 cm maximum tumor diameter and compared for radiological and blood-test parameters. Results: There were 330 males and 100 females. A higher percent of females had smaller tumors. The majority of patients had single tumors, but 15% of those with larger tumors had portal vein thrombosis (PVT) compared to 5% of those with smaller tumors. Significant differences between the tumor-size groups included alpha-fetoprotein (AFP) values and platelet counts, with thrombocytopenia and elevated bilirubin levels being associated with smaller tumors. In comparing PVT-positive and PVT-negative patients, AFP levels and platelet counts were also significantly different between the 2 groups. A mean multinomial multiple logistic regression model was developed for maximum tumor diameter plus PVT. Conclusions: The finding of larger tumors being associated with normal platelets and bilirubin levels in comparison to smaller tumors having thrombocytopenia reveals 2 different patterns of HCC presentation.