The hemoglobin, albumin, lymphocyte, and platelet (HALP) score as a prognostic marker for patients with upper tract urothelial carcinoma undergoing radical nephroureterectomy: a retrospective study from two centers

Tingyu Ye,Honghui Zhu,Tao Zhou,Binwei Lin,Fangyi Zhang,Xiaomin Gao,Zhixian Yu,Wei Chen,Maolin Hu,Qi Lin,Feng Lu,Peng Xia

doi:10.17305/bjbms.2021.6543

Abstract

The HALP score, which is the combination of hemoglobin, albumin, lymphocyte, and platelets has been confirmed as an important risk biomarker in several cancers. We aimed at evaluating the prognostic value of the HALP score in patients with non-metastatic upper tract urothelial carcinoma (UTUC). In this study, we retrospectively enrolled 533 of the 640 patients from two centers (315 and 325 patients, respectively) who underwent radical nephroureterectomy (RNU) for UTUC. The cutoff value of HALP was determined using the Youden index by performing receiver operating characteristic curve analysis. The relationship between post-operative survival outcomes and pre-operative HALP level was assessed using Kaplan-Meier and Cox regression analyses. As a result, the cutoff value of HALP was 28.67 and patients were then divided into HALP <28.67 group and HALP ≥28.67 group. Kaplan–Meier analysis and log-rank test revealed that HALP was significantly associated with overall survival (OS) (p < 0.001) and progression-free survival (PFS) (p < 0.001). Multivariate analysis demonstrated that a lower HALP score was an independent risk factor for OS (HR = 1.54, 95% CI, 1.14-2.01, p = 0.006) and PFS (HR = 1.44, 95% CI, 1.07-1.93, p = 0.020). Nomograms of OS and PFS incorporated with HALP score were more accurate in predicting prognosis than without it. The HALP score could also stratify patients for survival under different pathologic T stages in the subgroup analysis. Therefore, pretreatment HALP score was an independent prognostic factor of OS and PFS in UTUC patients undergoing RNU.

Highlights

Upper tract urothelial carcinoma (UTUC) is a rare malignancy, accounting for 5% of urothelial carcinomas [1, 2] and affecting up to 2 people per 100,000 [3]
In this study, we aimed to investigate whether preoperative HALP score could serve as an independent and strong risk factor of overall survival (OS) and progression-free survival (PFS) in UTUC patients
Univariate analysis demonstrated that aging, lower body mass index (BMI), presence of hydronephrosis, open surgical approach, lower HALP (OS: HR=2.45, 95%CI, 1.82-3.30, P

Summary

Introduction

Upper tract urothelial carcinoma (UTUC) is a rare malignancy, accounting for 5% of urothelial carcinomas [1, 2] and affecting up to 2 people per 100,000 [3]. Besides the traditional TNM system, accumulating evidence has demonstrated that hematological parameters, including neutrophil, lymphocyte, monocyte, and platelet counts and serum hemoglobin, albumin, and fibrinogen, play an important role in cancer progression and metastasis [5,6,7,8,9]. These inflammatory and nutritional indices have been shown to be closely related to the malignancy degree of cancer and long-term survival in patients with cancer after surgery [10]. The combination of hemoglobin, albumin, lymphocytes, and platelets (HALP) has been suggested to be a favorable risk predictor of patient survival in several solid tumors, including gastric [13], colorectal [14], pancreatic [15], renal [16], and bladder [17] cancers

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