Radiofrequency ablation is safe in patients with hepatocellular carcinoma and thrombocytopenia.

PURPOSE: This study aims to evaluate the safety and efficacy of radiofrequency ablation (RFA) in cirrhotic patients with hepatocellular carcinoma (HCC) and severe thrombocytopenia (platelet count < 50 × 10⁹/L).

METHODS

A retrospective analysis was conducted on 166 cirrhotic HCC patients who underwent RFA (Jan 2017 to Jan 2024). Patients were categorized into three groups based on preoperative platelet counts: Group A (≤ 30 × 10⁹/L), Group B (31-49 × 10⁹/L), and Group C (≥ 50 × 10⁹/L). The primary outcome was perioperative major hemorrhage. Secondary outcomes included postoperative complications, overall survival (OS), and tumor response.

RESULTS

Perioperative major hemorrhage occurred in 2.4% of patients (4/166), all in Group C (P = 0.287). Postoperative complications developed in 10.8% of cases (18/166), with comparable rates across groups (P = 0.95). The 90-day mortality rate was 1.8% (3/166), showing no intergroup difference (P = 0.304). Survival outcomes were similar among groups, with 1-/3-year survival rates of 100.0%/85.7% (Group A), 96.2%/88.1% (Group B), and 94.6%/84.4% (Group C) (P = 0.633). Tumor response rates did not differ significantly (P = 0.817), with complete response achieved in 83.3% of evaluable cases (135/162).

CONCLUSION

RFA is safe and effective for cirrhotic HCC patients with severe thrombocytopenia (< 50 × 10⁹/L), supporting the SIR guideline-recommended platelet threshold of > 30 × 10⁹/L for this high-risk population.

CLINICAL SIGNIFICANCE: RFA demonstrates high efficacy and safety in cirrhotic patients with HCC, even those with severe thrombocytopenia (< 50 × 10⁹/L). These findings not only validate the SIR guideline-recommended platelet threshold (> 30 × 10⁹/L) but also expand therapeutic options for this high-risk population.