Mean Platelet Volume and Unresectable Hepatocellular Carcinoma

Dear Editor, I read with great interest the article “Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma” by Scheiner et al. [1]. The study is interesting; however, I would like to point out certain issues regarding the mean platelet volume. Firstly, many factors influence the mean platelet volume, such as diabetes, obesity, hypertension metabolic syndrome, and even the use of certain antihypertensives [2]. The presence of these conditions will definitely confound the results, and they should have been excluded from the study population. Secondly, although it is relatively easy to obtain the mean platelet volume, the underlying principle of its measurement influences the results; therefore, the results will vary from the type of machine used [3]. In addition, the values also change depending on the duration between venipuncture and analysis and the type of anticoagulant used [3]. Thirdly, there are age and sex variations in the mean platelet volume, which could also be taken into account [4]. With so many confounding factors, it is difficult to make any conclusion, and a prospective study with a control population using the standard technique may give us a clear idea of the prognostic value of the mean platelet volume in hepatocellular carcinoma.