PROLONGED BLEEDING-TIME - A NEW CLINICAL MANIFESTATION OF HEPATOCELLULAR-CARCINOMA

The association between prolonged bleeding time and hepatocellular car cinoma (HCC) has not been well studied. We investigated whether bleedi ng time is prolonged in cirrhotic patients with HCC and studied the ro le of clinical characteristics, tumour size, and laboratory data in pr edicting bleeding time prolongation. After excluding patients that pre sented with blood dyscrasia and uraemia, 58 cirrhotic patients with HC C, 106 cirrhotic patients without HCC, and 44 age-and sex-matched heal thy subjects were included in the study. Bleeding time, imaging studie s, clinical characteristics and biochemical data were obtained for eve ry patient. Cirrhotic patients with and without HCC had longer bleedin g times (554 +/- 68 and 535 +/- 32 s, respectively) compared with heal thy controls (357 +/- 13 s, P < 0.05). Hepatocellular carcinoma patien ts with a large tumour burden (> 5 cm in diameter) had a significantly longer bleeding time than those patients without (663 +/- 105 vs 376 +/- 23 s, respectively, P < 0.05). After excluding patients with a pla telet count less than or equal to 80 000/mm(3), cirrhotic patients cla ssified as Child-Pugh's grading A and with a large tumour burden had l onger bleeding times (580 +/- 87 s) than patients with a small tumour burden (less than or equal to 5 cm in diameter) and cirrhotic patients without HCC (371 +/- 22 and 416 +/- 29 s, respectively, P < 0.05). In cirrhotic patients with HCC, higher serum bilirubin levels, a Child-P ugh's grading C, and a tumour size > 5 cm in diameter were found to be significant predictors for prolonged bleeding time on univariate anal ysis. On multivariate analysis, both tumour size > 5 cm in diameter an d a Child-Pugh's grading C (odd's ratio, 95% confidence interval and P value were measured as 38.5, 2.8-534.7, < 0.001, and 10.5, 0.9-117.6, 0.02, respectively) were the significant independent: predictors. A s ignificant correlation existed between tumour diameter and bleeding ti me (r = 0.44, P < 0.01). In conclusion, these results suggest that pro longed bleeding time may be categorized as a new clinical manifestatio n in patients with HCC. In addition to cirrhosis, HCC itself may also participate in the pathogenesis of bleeding time prolongation.