Radiofrequency ablation is safe in patients with hepatocellular carcinoma and thrombocytopenia

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).

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.

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).

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.

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.