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Response to the Letter to the Editor Concerning the Publication “Association of Platelet Count and Mean Platelet Volume with Overall Survival in Patients with Cirrhosis and Unresectable Hepatocellular Carcinoma”

Dear Editor, We want to thank Dr. Bakshi for his great interest in our paper [1] and are happy to respond to his comments [2]. We agree that several factors may have influenced the mean platelet volume (MPV), but even if they did, our results show that larger MPV – no matter what caused it – was associated with longer survival in two large, independent cohorts. It is also possible that the assessment of MPV may be subject to variability to some degree. However, the large sample size of our cohort, the validation of our results in an independent cohort, and the fact that MPV was associated with survival in other cancer types [3–5] as well supports the validity of our findings. Given the retrospective nature of our study, it is impossible to control for potential confounders. Thus, our results can only be seen as associations, and we agree with the author that a prospective study would help to better understand the role of MPV in patients with hepatocellular carcinoma. Received: August 13, 2019 Accepted: August 15, 2019 Published online: October 16, 2019